ASSOCIATION OF ESOPHAGEAL AND GASTRIC VARICES WITH OTHER PHENOTYPIC STIGMAS OF EPATIC CIRRHOSIS
Abstract
Background. Portal hypertension resulted from the increased pressure in the portal system is one of the leading syndromes of liver cirrhosis. A frequent and often fatal manifestation of portal hypertension is upper gastrointestinal bleeding mainly due to varicose veins of the esophagus and the stomach. Objective. To study the prevalence of esophageal and gastric varices and their association with other phenotypic stigmas of cirrhosis. Material and methods. A total of 108 patients with cirrhosis, including 46 (42.59%) men and 62 (57.41%) women, were included in the study. Results. Varicose veins were detected in 77 (71,3%) of 108 examined patients. All varices were localized in the esophagus. Of all patients examined, 36 patients (33.33%) were Child-Pugh class A, 58 patients (53.70%) were class B, and 14 patients (12.96%) were class C. Among Class A patients, 9 patients (11.7%) had grade I varicose veins, 9 patients (11.7%) had grade II, 8 patients (10.4%) had grade III, while 13 patients (16.9%), 24 patients (31.2%) and 3 patients (3.9%) had grade B varicose veins, respectively. All patients classified as class C had large varicose veins. The size of varices was associated with the severity of liver cirrhosis (τ=0.2, 95% CI: p˂0.05). Grade II-III varices were seen in 55 patients (50.9%), 9 of whom (16.4%) had a history of gastrointestinal bleeding. Such complication was not observed in any patient with class A cirrhosis, but occurred in all patients with Child-Pugh class C cirrhosis. Conclusions. Patients with liver cirrhosis should undergo follow-up upper GI endoscopy for early detection of varices and, if necessary, for prescription of prophylactic therapy to reduce the risk of bleeding and associated high mortality.
References
Habibullaev ShR. Krovotechenie iz varikozno-rasshirennyh ven pishhevoda pri sindrome portalnoj gipertenzii [Bleeding from varicose veins of the esophagus in case of portal hypertension syndrome]. Re-health journal. 2020(4):76-79. (Russian). https://doi.org/10.24411/2181-0443/2020-10171. https://www.elibrary.ru/yskxnh.
Ajayia AO, Ajayia EA, Raimia TH, Fadarea JO, Solomonb OA, Adeotia AO. Oesophageal varices in patients with liver cirrhosis. Scientific Journal of Medical Science. 2013;2(11):212-218. https://doi.org/10.14196/sjms.v2.i11.1027.
Kitsenko EA, Anisimov AY, Andreev AI. Sovremennoe sostojanie problemy krovotechenij iz varikozno-rasshirennyh ven pishhevoda i zheludka [The modern state of bleeding from variceal enlarged veins of esophagus and stomach]. Vestnik sovremennoj klinicheskoj mediciny [Bulletin of modern clinical medicine]. 2014;7(5):89-98. edn: SNXAUF. (Russian).
Horonko JuV, Dmitriev AV, Shitikov IV, Blikjan AV, Kozyrevskij MA. Sovremennye vozmozhnosti jendoskopicheskoj diagnostiki i lechenija varikoznyh pishhevodno-zheludochnyh krovotechenij pri portalnoj gipertenzii. Sovremennye problemy nauki i obrazovanija [Internet]. 2016;6. Available from: https://science-education.ru/ru/article/view?id=25736. (Russian).
Ministerstvo zdravoohranenija Respubliki Belarus. Ob utverzhdenii klinicheskogo protokola „Diagnostika i lechenie pacientov s zabolevanijami organov pishhevarenija”. Postanovlenie № 54 (june 1, 2017) [Internet]. Available from: https://science-education.ru/ru/article/view?id=25736. (Russian).
Soehendra N, Binmoeller KF, Seifert H, Schreiber HW. Therapeutic endoscopy: color atlas of operative techniques for the gastrointestinal tract. 2nd ed. Stuttgart: Thieme; 2005. 208 p.
Mironov PI. Jeticheskaja jekspertiza klinicheskih issledovanij: Helsinskaja deklaracija-2008 [Ethical expertise of clinical investigations: Helsinki declaration-2008]. Medicinskij vestnik Bashkortostana [Bashkortostan Medical Journal]. 2009;4(6):82-86. edn: KYLCZH. (Russian).
Dite P, Labrecque D, Fried M, Gangl A, Khan AG, Bjorkman D, Eliakim R, Bektaeva R, Sarin SK, Fedail S, Krabshuis JH, Le Mair A. Varikozno rasshirennye veny pishhevoda. Prakticheskie rekomendacii Vsemirnoj Gastrojenterologicheskoj Organizacii. Milwaukee: Vsemirnaja gastrojenterologicheskaja organizacija; 2008; 21 p. (Russian).
LaBrecque D, Khan AG, Sarin SK, Le Mair AW (Revision authors); LaBrecque D, Dite P, Fried M, Gangl A, Khan AG, Bjorkman D, Eliakim R, Bektaeva R, Sarin SK, Fedail S, Krabshuis JH, Le Mair AW (Original Review team). Esophageal varices. WGO Practice Guideline. Milwaukee: World Gastroenterology Organisation; 2013. 14 p.
Sumon SM, Sutradhar SR, Chowdhury M, Khan NA, Uddin MZ, Hasan MI, Rozana FK, Haque MF, Barman TK, Ferdous J. Relation of different grades of esophageal varices with Child-Pugh classes in cirrhosis of liver. Mymensingh Med J. 2013;22(1):37-41.
Filin AV, Mjaukina LM, Kim EV, Filin AA. Jendoskopicheskaja diagnostika, pervichnaja i vtorichnaja profilaktika krovotechenij iz varikozno rasshirennyh ven pishhevoda i zheludka [Endoscopic diagnostics, primary and secondary prevention of bleeding from varicose veins of the esophagus and stomach]. Prakticheskaja medicina [Practical medicine]. 2008;2(26):37-40. edn: LEYUYV. (Russian).
Korobka VL, Pak ES, Kostrykin MYu, Tkachev АV, Balin NI. Shapovalov AM, Babieva AM. Ocenka chetyrehletnego opyta vedenija pacientov s krovotechenijami iz varikozno rasshirennyh ven pishhevoda v liste ozhidanija transplantacii pecheni v Rostovskoj oblasti [Analysis of four-year management of patients with varicose bleeding in the waiting list for liver transplantation in Rostov Region]. Vestnik Volgogradskogo gosudarstvennogo medicinskogo universiteta [Journal of Volgograd State Medical University]. 2020;3(75):151-155. https://doi.org/10.19163/1994-9480-2020-3(75)-151-155. https://www.elibrary.ru/idgifv. (Russian).
de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959-974. https://doi.org/10.1016/j.jhep.2021.12.022.
