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Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease.
Am J Gastroenterol. 1999 Nov; 94(11):3292-6.AJ

Abstract

OBJECTIVE

Recently it has been recommended that all cirrhotic patients without previous variceal hemorrhage undergo endoscopic screening to detect varices and that those with large varices should be treated with beta-blockers (American College of Gastroenterology guidelines). However, endoscopic screening only of patients at highest risk for varices may be the most cost effective.

METHODS

Ninety-eight patients without a history of variceal hemorrhage underwent esophagogastroduodenoscopy as part of a liver transplant evaluation. Univariate/multivariate analysis was used to evaluate associations between the presence of varices and patient characteristics including etiology of liver disease, Child-Pugh class, physical findings (spider angiomata, splenomegaly, and ascites), encephalopathy, laboratory parameters (prothrombin time, albumin, bilirubin, BUN, creatinine, and platelets), and abdominal ultrasound findings (portal vein diameter/flow, splenomegaly, and ascites).

RESULTS

The causes of cirrhosis among the 67 men and 31 women (mean age, 48 yr) included 28% Hepatitis C/alcoholism, 25% Hepatitis C, 13% alcoholism, 9% primary sclerosing cholangitis/primary biliary cirrhosis, 9% cryptogenic, 6% Hepatitis B, 1% Hepatitis B and C, and 9% other. Patients were Child-Pugh class A 34%, B 51%, and C 15%. Endoscopic findings included esophageal varices in 68% of patients (30% were large), gastric varices in 15%, and portal hypertensive gastropathy in 58%. Platelet count <88,000 was the only parameter identified by univariate/multivariate analysis (p < 0.05) as associated with the presence of large esophageal varices (odds ratio 5.5; 95% confidence interval 1.8-20.6) or gastric varices (odds ratio 5; 95% confidence interval 1.4-23).

CONCLUSIONS

Platelet count <88,000 is associated with the presence of esophagogastric varices. A large prospective study is needed to verify and validate these findings and may allow identification of a group of patients who would most benefit from endoscopic screening for varices.

Authors+Show Affiliations

Department of Medicine, Oregon Health Sciences University, Portland 97201, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10566732

Citation

Zaman, A, et al. "Factors Predicting the Presence of Esophageal or Gastric Varices in Patients With Advanced Liver Disease." The American Journal of Gastroenterology, vol. 94, no. 11, 1999, pp. 3292-6.
Zaman A, Hapke R, Flora K, et al. 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., Hapke, R., Flora, K., Rosen, H. R., & Benner, K. (1999). Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. The American Journal of Gastroenterology, 94(11), 3292-6.
Zaman A, et al. Factors Predicting the Presence of Esophageal or Gastric Varices in Patients With Advanced Liver Disease. Am J Gastroenterol. 1999;94(11):3292-6. PubMed PMID: 10566732.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors predicting the presence of esophageal or gastric varices in patients with advanced liver disease. AU - Zaman,A, AU - Hapke,R, AU - Flora,K, AU - Rosen,H R, AU - Benner,K, PY - 1999/11/24/pubmed PY - 1999/11/24/medline PY - 1999/11/24/entrez SP - 3292 EP - 6 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 94 IS - 11 N2 - OBJECTIVE: Recently it has been recommended that all cirrhotic patients without previous variceal hemorrhage undergo endoscopic screening to detect varices and that those with large varices should be treated with beta-blockers (American College of Gastroenterology guidelines). However, endoscopic screening only of patients at highest risk for varices may be the most cost effective. METHODS: Ninety-eight patients without a history of variceal hemorrhage underwent esophagogastroduodenoscopy as part of a liver transplant evaluation. Univariate/multivariate analysis was used to evaluate associations between the presence of varices and patient characteristics including etiology of liver disease, Child-Pugh class, physical findings (spider angiomata, splenomegaly, and ascites), encephalopathy, laboratory parameters (prothrombin time, albumin, bilirubin, BUN, creatinine, and platelets), and abdominal ultrasound findings (portal vein diameter/flow, splenomegaly, and ascites). RESULTS: The causes of cirrhosis among the 67 men and 31 women (mean age, 48 yr) included 28% Hepatitis C/alcoholism, 25% Hepatitis C, 13% alcoholism, 9% primary sclerosing cholangitis/primary biliary cirrhosis, 9% cryptogenic, 6% Hepatitis B, 1% Hepatitis B and C, and 9% other. Patients were Child-Pugh class A 34%, B 51%, and C 15%. Endoscopic findings included esophageal varices in 68% of patients (30% were large), gastric varices in 15%, and portal hypertensive gastropathy in 58%. Platelet count <88,000 was the only parameter identified by univariate/multivariate analysis (p < 0.05) as associated with the presence of large esophageal varices (odds ratio 5.5; 95% confidence interval 1.8-20.6) or gastric varices (odds ratio 5; 95% confidence interval 1.4-23). CONCLUSIONS: Platelet count <88,000 is associated with the presence of esophagogastric varices. A large prospective study is needed to verify and validate these findings and may allow identification of a group of patients who would most benefit from endoscopic screening for varices. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/10566732/Factors_predicting_the_presence_of_esophageal_or_gastric_varices_in_patients_with_advanced_liver_disease_ L2 - https://Insights.ovid.com/pubmed?pmid=10566732 DB - PRIME DP - Unbound Medicine ER -