Abstract
Esophageal varices in liver cirrhosis is a major complication increasing its morbidity and mortality. Prevalence of esophageal varices in liver cirrhosis range from 60-80 %. Patients with cirrhosis should be screened for varices with esophageal endoscopy. Endoscopy is an invasive procedure and also may not be affordable for ordinary people in developing countries. This study aims to find out diagnostic efficacy of non invasive marker for detecting esophageal varices.
Materials and Methods: It is a Diagnostic test evaluation study of 1 year duration conducted in 140 cirrhotic patients admitted on Medicine and Gastroenterology ward in a tertiary care centre. Data collected and analysed using SPSS. ROC curve was drawn with different cut offs for Platelet count/Spleen thickness and AST/ALT ratio.
Result: PLC/ BPD ratio have sensitivity 74 % and specificity 88% which is statistically significant with a p value <.001. This ratio have a cut off value 919 with area under ROC curve 0.908 which denotes a good test. AST/ALT ratio have sensitivity 74% specificity 82 % which is statistically significant with a p value < .001 and the ratio have a cut off value 1.30 with area under ROC curve 0.794
Conclusion: Platelet count/spleen diameter ratio and AST/ALT ratio may be used as non invasive marker for esophageal varices in cirrhotic patients
Keywords: Esophageal varices, Endoscopy, Cirrhosis, Platelet count, spleen diameter, AST, ALT.
References
- Schiedermaier P. Splanchnic hemodynamics: cirrhotic versus non-cirrhotic portal hypertension. J Gastroenterol Hepatol 2004;19(s7):S150-S4.
- Hong WD, Zhu QH, Huang ZM, Chen XR, Jiang ZC, Xu SH, et. Predictors of esophagealvarices in patients with HBV-related cirrhosis: a retrospective study. BMC Gastroenterol. 2009;9:11.
- Jensen DM. Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes. Gastroenterology 2002;122(6):1620-30.
- Garceau AJ, Chalmers TC. The Boston Inter-Hospital Liver Group. The natural history of cirrhosis: I. Survival with oesophageal varices NEJM1963;268:469–73
- Graham D, Smith JL. The course of patients after variceal hemorrhage. Gastroenterology 1981;80;800–9.
- Rigo GP, Merighi A, Chalen JN, et al. A prospective study of the ability of three endoscopic classifications to predict hemorrhage from esophagealvarices. Gastrointest Endosc 1992;38:425–9
- Jensen DM. Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes. Gastroenterology 2002;122:1620–30.
- Grace ND, Groszmann RJ, Garcia-Tsao G, et al. Portal hypertension andvariceal bleeding: an AASLD single topic symposium. Hepatology 1998;28:868–80.
- D’Amico G, Garcia-Tsao G, Calés P, et al. Diagnosis of portal hypertension: how and when. In: De Franchis R, ed. Proceedings of the Third Baveno International Consensus Workshop on Definitions, Methodology and Therapeutic Strategies. Oxford: Blackwell Science 2001;36–63.
- Calés P, Desmorat H, Vinel JP, et al. Incidence of large oesophageal varices in patients with cirrhosis: application to prophylaxis of first bleeding. Gut 1990;31:1298–302
- de Franchis R. Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. 2000;33(5):846-52.
- de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol.2005;43(1):167-76.
- Gorka W, al Mulla A, al Sebayel M, Altraif I, Gorka Qualitative hepatic venous Doppler sonography versus portal flowmetry in predicting the severity of esophagealvarices in hepatitis C cirrhosis.AJR Am J Roentgenol. 1997;169(2):511-5.
- Lavergne J, Molina E, Reddy KR, Jeffers L, Leon R, Nader AK, et al.Ascites predicts the presence of high grade varices by screening gastroscopy. Gastrointest Endosc. 1997;45(4):AB187.
- Pilette C, Oberti F, Aube C, Rousselet MC, Bedossa P, GalloisY, et al. Noninvasive diagnosis of esophageal-varices in chronic liver diseases. J Hepatol. 1999;31(5):867-73.
- Madhotra R, Mulcahy HE, Willner I, Reuben A. Prediction of esophagealvarices in patients with cirrhosis.j Clin Gastroenterol. 2002;34(1):81-5
- McCormick PA. The spleen, hypersplenism, and other relationships between the liver and spleen. In: Bircher J, Benhamou J-P, McIntyre N, eds. Oxford Textbook of Clinical Hepatology. Oxford: Oxford University Press,1999:787–95.
- Schepis F, Camma C, Niceforo D, Magnano A, Pallio S, Cinquegrani M, et al. Which patients with cirrhosis should undergo endoscopic screening for esophagealvarices detection? Hepatology. 2001;33(2):333-8.
- Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM, et al. Predictors of large esophagealvarices in patients with cirrhosis. Am J Gastroenterol. 1999;94(11):3285-91.
- Ng FH, Wong SY, Loo CK, Lam KM, Lai CW, Cheng CS. Prediction Of esophagogastric varices in patients with liver cirrhosis. J Gastroenterol Hepatol. 1999;14(8):785-90.
- Zaman A, Hapke R, Flora K, Rosen HR, Benner K. Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. Am J Gastroenterol. 1999;94(11):3292-6.
- Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med. 2001;161(21):2564-70.
- Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52(8):1200-5.
- Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000;14(Suppl D):60D-6D.
- de Franchis R. Noninvasive diagnosis of esophagealvarices: is it feasible? Am J Gastroenterol. 2006;101(11):2520-2.
Corresponding Author
Suresh Raghavan
Professor of Medicine, Department of Medicine,
Government Medical College, Alappuzha
Mobile: 9847155537. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.33
