Title: Correlation between Serum Ascites Albumin Gradient and Esophageal Varices in Patients of Chronic Liver Disease
Authors: Ajeet Kumar Chaurasia, BD Mangal
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.48
Introduction:Clinically significant portal hypertension is present in >60% of patient with liver cirrhosis. Ideally portal hypertension should be evaluated by actually measuring portal pressure, but it is invasive procedure and involves catheterization of hepatic vein not applicable on a routine basis. Ascites and esophageal varices both are the complication of portal hypertension. Therefore predicting the presence of varices by ascitic fluid examination may be helpful. Aim of Study:To study the correlation between SAAG and presence and grades of esophageal varices in CLD. Result:A total of 51 patients were studied which included 29 Alcoholic and 22 non Alcoholic CLD. These patients were devided into 3 groups - Group A with SAAG = 1.1-1.49 (6 patients), Group B with SAAG = 1.5-1.99 (21 patients) and Group C with SAAG > 2.0 (24 patients). In group A, 33% patient had varices, In group B, 76.1% had varices while in group C all the 24 patients (100%) had varices (p<0.05). Among alcoholic 26 out of 29 patients had varices while among non- alcoholic 16 out of 22 patients had varices (Z=1.70). Conclusion:We concluded in our study that there was significant correlation between SAAG value and endoscopic parameter of portal hypertension manifested by presence of varices. But the SAAG value has no significant correlation with severity of varices. This correlation exist in both alcoholic as well non- alcoholic liver disease, though there is proportionate difference among both these group and correlation is weaker in non-alcoholic liver disease. Keywords: SAAG, Portal Hypertension, Esophageal Varices, CLD, Liver cirrhosis. 1. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG, The serum-ascites albumin gradient is superior to the exudate-transudate concept in the differential diagnosis of ascites. Ann Intern Med. 1992 Aug 1;117(3):215-20. 2. Akriviadis EA, Kapnias D, Hadjigavriel M, Mitsiou A, Goulis J, Serum/ascites albumin gradient: its value as a rational approach to the differential diagnosis of ascites, Scand J Gastroenterol. 1996 Aug;31(8):814-7. 3. Rector WG Jr., Reynolds TB, Superiority of the serum-ascites albumin difference over ascites total protein concentration in separation of "transudative" and "exudative" ascites, Am J Med 1984;47:83-85. 4. Alba D, Torres E, Vázquez JJ, Sero-ascitic gradient of albumin: usefulness and diagnostic limitations, An Med Interna. 1995 Aug;12(8):404-7. 5. S.Wongcharatrawee,and R.Groszmann- Hemodynamic assessment in clinical practice in portal hypertensive cirrhotics, ANNALS OF GASTROENTEROLOGY 2001, 14(3):158-165 6. MacMathuna PM: Mechanisms and consequences of portal hypertension, Drugs. 1992;44 Suppl 2:1-13; discussion 70-2. 7. Rousselot LM. The role of congestion (portal hypertension) in so called Banti’s syndrome: a clinical and pathological study of thirty one cases with late results follwing spleenectomy, J Am Med assoc 1936;107:1788-1793. 8. Thompson WP, Caughey JL, Whipple AO, Rousselot LM, Spleenic vein pressure in congestive spleenomegaly (Banti’s syndrome). J Clin Invest 1937;16:571-572. 9. Friedman EW, Weisner RS, Estimation of hepatic sinuside pressure by means of venous catheter and estimation of portal pressure by hepatic vein catheterization, Am J Physiol 1951; 165;527-531. 10. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, Mele MR, Testa E, Mansi C, Savarino V, Testa R, 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 Aug;52(8):1200-5. 11. Paquet KJ, Prophylactic endoscopic sclerosing treatment of esophageal wall in varices: A prospective controlled trial, Endoscopy. 1982;14:4–5 [PubMed] 12. Hoefs JC, Serum protein concentration and portal pressure determine the ascitic fluid protein concentration in patients with chronic liver disease. J Lab Clin Med 1983;102:260-273. 13. Kajani MA, Yoo YK, Alexander JA, Gavaler JS, Stauber RE, Dindzans VJ, Van Thiel DH: Serum-ascites albumin gradients in nonalcoholic liver disease. Dig Dis Sci. 1990 Jan;35(1):33-7. 14. Al-Knawy BA. Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease. Ann Saudi Med 1997;17:26-28. 15. Torres E, Barros P, Calmet F: Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension. Am J Gastroenterol. 1998 Nov;93(11):2172-8. 16. Gurubacharya DL, Mathura KC, Karki DB, Correlation between serum-ascites albumin concentration gradient and endoscopic parameters of portal hypertension, Kathmandu Univ Med J (KUMJ). 2005 Oct-Dec;3(4):327-33. 17. Demirel U, Karincaoglu M, Harputluoglu M, Ateş M, Seçkin Y, Yildirim B, Hilmioglu F, Two findings of portal hypertension: Evaluation of correlation between serum-ascites albumin gradient and esophageal varices in non-alcoholic cirrhosis, Turk J Gastroenterol. 2003 Dec;14(4):219-22. 18. Efrain T, Pedro B, Fernando C, Correlation between serum ascites albumin concentration gradient and endoscopic parameter of portal hypertension, Am J Gastroenterology. 1998; 93 (11): 2172-2178. 19. Goran Bjelakovic, Aleksandar Nagorni , Ivanka Stamenkovic , Daniela Benedeto-Stojanov, Vesna Brzacki, Suzana Raicevic, Biljana Radovanovic, Marija Bjelakovic, Vuka Katic, Vesna Zivkovic , Dragomir Vucetic, The value of Serum Ascites albumin gradient in differential diagnosis of ascites and the proposal for the new cut off Value, ACTA FAC. MED. NAISS. 2003; 20 (4): 209-212.Abstract
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