Non invasive predictors of esophageal varices in patients with chronic liver disease Short observational study.

Dr Mohini Singh; Dr Rajkumar. M; Dr Immanuel Arunkumar; Dr Vaiera Manigandan

Volume : VII, Issue : XI, November - 2017

Non invasive predictors of esophageal varices in patients with chronic liver disease Short observational study.

Dr Mohini Singh, Dr Rajkumar. M, Dr Immanuel Arunkumar, Dr Vaiera Manigandan

Abstract :

Cirrhosis, is a final pathway for a wide variety of chronic liver diseases. Chronic liver disease of any etiology can result in portal hypertension. Portal hypertension leads to the formation of porto – systemic collaterals including gastroesophageal varices. A major cause of death in patients with cirrhosis is gastrointestinal hemorrhage. Esophago–gastroduodenoscopy is the gold standard for the detection of esophageal varices, but several non invasive predictors of esophageal varices can be studied for the prediction of esophageal varices and those at risk of bleeding.

Aims and objectives –

To analyse the biochemical, clinical and radiological parameters which correlate with the presence of esophageal varices on upper GI endoscopy in patients with chronic liver disease.

Materials and methods –

This observational study included 293 patients with chronic liver disease and the laboratory and radiological variables were compared between patients with varices and non varices.

Results –

In this study male patients contributed a much higher proportion in both groups with alcohol being the commonest cause for cirrhosis, among 147 patients with esophageal varices, grade III varices was noted in 44% and 86% with varices had ascites. Patients in varices group had a lower mean platelet count, higher mean bilirubin levels, higher mean spleen diameter and higher mean portal vein diameter. The ratio of platelet count by spleen diameter showed a significantly lower value in patients with varices. 67% of patients with varices had a platelet count /spleen diameter ratio < 1000 and 50% of the patients with platelet count/ spleen diameter ratio < 1000 had grade III varices. The mean portal diameter was significantly higher in patients with varices (13.18 mm) compared with non variceal group (12.37 mm). Analysis between Child Pugh score and grade of varices revealed a significantly higher proportion of patients with Child Pugh score C having grade III varices. A higher proportion of patients with varices (68 out of 147 patients) had Model for End Stage Liver Disease (MELD) score between 12 –18. 34.7% of patients with varices had Aspartate transaminase to platelet ratio index (APRI) > 1.5.

Conclusion –

Non invasive parameters are very useful in predicting the presence of esophageal varices in cirrhotic patients and more studies in this realm must be undertaken in the future to reduce the burden of invasive endoscopic procedures.