జర్నల్ ఆఫ్ క్లినికల్ గ్యాస్ట్రోఎంటరాలజీ అండ్ హెపటాలజీ అందరికి ప్రవేశం

నైరూప్య

Non-Invasive Predictors of Large Esophageal Varices in Patients with Cirrhosis in Cameroon

Nsenga Djapa Guy Roger*, Kowo Pierre Mathurin, Mohamadou Galdima, Ndjitoyap Ndam Antonin Wilson, Talla Paul, Ankouane Andoulo Firmin, Njoya Oudou

Background: Esophageal varices (EVs) are a consequence of portal hypertension in patients with chronic liver diseases. Current guidelines recommend that all patients with cirrhosis should undergo screening endoscopy at diagnosis to identify varices at high risk of bleeding which will benefit from primary prophylaxis. This study was conducted to evaluate known noninvasive predictors of large esophageal varices in Cameroon.

Patients and methods: Patients with liver cirrhosis seen from November 2013 to October 2014, meeting our selection criteria were consecutively enrolled. Demographic data (age and sex), relevant clinical (ascites, encephalopathy), biological (platelet count, bilirubinemia, albuminemia and prothrombin level), ultrasonographic (spleen diameter, portal vein diameter, right liver span and ascites) and endoscopic (EV, gastric varives, portal hypertensive gastropathy and ulcers) parameters were assessed. Univariate and multivariate analysis was done on the data for predictors of large EVs. Statistical significance was reached with a p ≤ 0.05.

Results: A total of 64 patients were enrolled in our study. The mean age was 51 ± 18.09 years, with a male predominance (1.78). Viral hepatitis accounted for the majority of causes of cirrhosis (51.6% were related to hepatitis B while 46.9% were related to hepatitis C). Nine patients (14.1%) had alcohol related cirrhosis. Thirty three (51.56%) presented with ascites. Child Pugh score, spleen diameter, albumin level, platelet on spleen diameter and right liver span on albumin ratios were significantly associated with the presence of esophageal varices. Spleen diameter, Child Pugh score and right liver span on albumin ratio had the best positive predictive values (PPV) of the presence of large esophageal varices with cut offs of 148.34 mm (PPV=74.4%), 9 (PPV=72.4%), and 4.4574 (PPV=66.7%) respectively. Child Pugh score, spleen diameter, platelet count on spleen diameter and right liver span on albumin ratios were independent predictors of esophageal varices. There was no correlation between bilirubin level, portal vein diameter and EV.

Conclusion: Child Pugh score, spleen diameter, albumin level, platelet on spleen diameter and right liver span on albumin ratios are good predictors of EV. Though the predictive values were generally low, spleen diameter, Child Pugh score and right liver span on albumin ratio were best at predicting large EV. There was no correlation between bilirubin level, portal vein diameter and EV.