Non-invasive diagnosis of esophageal varices in chronic liver diseases
Section snippets
Patients
The 243 consecutive patients considered for this study were admitted to the hepatogastroenterology unit of the University Hospital in Angers, France, in 1994–5 for alcoholism or alcoholic liver disease, or for chronic hepatitis B or C infection. Patients were included who had drunk at least 50 g of alcohol per day for the past 5 years, who were positive for hepatitis B surface antigen or C serum markers, and who had had persistently elevated serum aminotransferases >1.5 N for at least 6 months
Characteristics of population
Among the 207 patients included, 66% were male and the mean age was 50±12 years. The prevalence of cirrhosis was significantly higher in patients with alcoholic CLD than in patients with viral CLD (60.5 vs 42%, respectively, p<0.05). The distribution of EV was as follows: in the 91 patients with CLD, EV were present in 10%, all grade 1; in the 116 patients with cirrhosis EV were present in 72% with grade 1 in 28%, grade 2 in 42% and grade 3 in 2%. The distribution of Child-Pugh classes in
Discussion
The prevalence of cirrhosis in developed countries ranges between 0.4% in the USA or France 19., 20. and 1.1% in Italy (21). PHT and liver dysfunction are the most frequent complications of cirrhosis. The main consequence of PHT is the development of collateral circulation, including EV which are the most frequent and most dangerous complication. EV and variceal bleeding are an early complication of cirrhosis justifying early screening for EV (4). The usual means of diagnosing EV is upper
Acknowledgements
We thank Pr. Daniel Chappard for his contribution to image analysis and Ms Dale Roche for her contribution.
References (40)
- et al.
Gastroesophageal endoscopic signs of cirrhosis: independent diagnostic accuracy, interassociation and relationship to etiology and hepatic dysfunction
Gastrointest Endosc
(1998) - et al.
Non invasive diagnosis of hepatic fibrosis or cirrhosis
Gastroenterology
(1997) - et al.
Gastroesophageal endoscopic features in cirrhosis: observer variability, interassociations and relationship to hepatic dysfunction
Gastroenterology
(1990) - et al.
Echographic diagnosis of hepatic fibrosis or cirrhosis
J Hepatol
(1999) - et al.
Noninvasive prediction of fibrosis in C282Y homozyous hemochromatosis
Gastroenterology
(1998) - et al.
Prospective evaluation of esophageal varices in primary biliary cirrhosis: development, natural history, and influence on survival
Gastroenterology
(1989) - et al.
Ascites predicts the presence of high grade varices by screening gastroscopy
Gastrointest Endosc
(1997) - et al.
A predictive index for determining the risk for presence of large esophageal varices in patients with cirrhosis
Gastroenterology
(1998) - et al.
Prothrombin time in liver failure: time, ratio, activity percentage, or international normalized ratio?
Hepatology
(1996) - et al.
Histopathological evaluation of liver fibrosis: quantitative image analysis vs semi-quantitative scores. Comparison with serum markers
J Hepatol
(1998)
Effects of simvastatin, pentoxyfylline and spironolactone on hepatic fibrosis and portal hypertension in cirrhotic rats
J Hepatol
Main causes of death in cirrhosis
Scand J Gastroenterol
Histoire naturelle des varices œsophagiennes au cours de la cirrhose (de la naissance à la rupture)
Gastroenterol Clin Biol
Beta-adrenergicantagonist drugs in the prevention of gastrointestinal bleeding in patients with cirrhosis and esophageal varices
N Engl J Med
Incidence of large esophageal varices in patients with cirrhosis. Application to prophylaxis of first bleeding
Gut
Predicting esophageal varices in patients with primary biliary cirrhosis (PBC)
Gastroenterology
Serum laminin Pl levels do not reflect critically elevated portal pressure in patients with liver cirrhosis
Hepato-Gastroenterology
Portal hypertensive gastric mucosa: an endoscopic study
Gut
Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy
Gut
Frequency of upper gastrointestinal lesions in patients with liver cirrhosis
Dig Dis Sci
Cited by (141)
Novel albumin, bilirubin and platelet criteria for the exclusion of high-risk varices in compensated advanced chronic liver disease: A validation study
2021, Clinics and Research in Hepatology and GastroenterologyEvaluation of three “beyond Baveno VI” criteria to safely spare endoscopies in compensated advanced chronic liver disease
2019, Digestive and Liver DiseaseThe noninvasive diagnosis of esophageal varices and its application in clinical practice
2018, Clinics and Research in Hepatology and GastroenterologyNon-invasive Diagnosis of Oesophageal Varices Using Systemic Haemodynamic Measurements by Finometry: Comparison with Other Non-invasive Predictive Scores
2016, Journal of Clinical and Experimental HepatologyCitation Excerpt :As increasing numbers of patients require endoscopic surveillance for varices, increasing interest is being shown in the non-invasive diagnosis of oesophageal varices, due to the cost and burden this places on endoscopy units and the requirement for repeated surveillance over many years. Multiple studies have been performed assessing parameters relating to liver function, liver fibrosis, portal hypertension and hypersplenism, and combining modalities to produce predictive scores, but to date none of these have proved accurate enough to replace the current gold standard of gastroscopy.9–20 Portal hypertension is the force that drives the development of oesophageal varices in cirrhotic patients.
Incidence and predictors of rebleeding after band ligation of oesophageal varices
2014, Arab Journal of Gastroenterology