Varices

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Varices

  • esophageal varices
  • fundic varices
  • gastric fundic varices
  • gastric varices
  • gastroesophageal varices
  • oesophageal varices
  • oesophagogastric varices


  • Selected Abstracts


    GENERAL RULES FOR RECORDING ENDOSCOPIC FINDINGS OF ESOPHAGOGASTRIC VARICES (2ND EDITION)

    DIGESTIVE ENDOSCOPY, Issue 1 2010
    Takashi Tajiri
    General rules for recording endoscopic findings of esophageal varices were initially proposed in 1980 and revised in 1991. These rules have widely been used in Japan and other countries. Recently, portal hypertensive gastropathy has been recognized as a distinct histological and functional entity. Endoscopic ultrasonography can clearly depict vascular structures around the esophageal wall in patients with portal hypertension. Owing to progress in medicine, we have updated and slightly modified the former rules. The revised rules are simpler and more straightforward than the former rules and include newly recognized findings of portal hypertensive gastropathy and a new classification for endoscopic ultrasonographic findings. [source]


    HEMODYNAMIC MECHANISM OF ESOPHAGEAL VARICES

    DIGESTIVE ENDOSCOPY, Issue 1 2006
    Katsutoshi Obara
    We investigated the correlation between the collaterals around the esophagus and recurrence of esophageal varices in patients with portal hypertension who had undergone endoscopic injection sclerotherapy (EIS). In patients with portal hypertension, many types of collaterals around the esophagus were visualized by endoscopic ultrasonography (EUS). The collaterals outside the esophageal wall detected by EUS were divided into two groups according to the location of the veins: peri-esophageal collateral veins (peri-ECV) and para-esophageal collateral veins (para-ECV) Perforating veins are those that have penetrated the esophageal wall and have connected with either peri-ECV or para-ECV. We demonstrated that severe peri-ECV and large perforating veins play an important role in the development of esophageal varices in untreated patients with portal hypertension. The results of our investigation have shown that detection of peri-ECV and perforating veins by EUS and treatment of them by EIS appears to be important for the treatment of esophageal varices. The disappearance of peri-ECV by EIS is essential for reducing the recurrence rate of esophageal varices. To prevent variceal recurrence, a mucosal fibrosing method using argon plasma coagulation has been widely performed in Japan. If EUS abnormalities are associated with variceal recurrence, we recommend the use of the mucosal fibrosing method. In conclusion, the presence of severe peri-ECV and large perforating veins in the esophageal wall strongly correlate with the recurrence of esophageal varices in patients with portal hypertension. An understanding of these EUS abnormalities on the basis of hemodynamics around the esophagus is important for the management of esophageal varices in patients with portal hypertension. [source]


    GASTRIC FUNDIC VARICES: HEMODYNAMICS AND NON-SURGICAL TREATMENT

    DIGESTIVE ENDOSCOPY, Issue 3 2005
    Seishu Hayashi
    The hemodynamics and non-surgical treatment of gastric fundic varices (FV) are reviewed. FV are more frequently supplied by the short and posterior gastric veins than esophageal varices (EV), and are formed mostly by large spontaneous shunts in which the gastric or splenic vein is continuous with the left renal vein via the inferior phrenic veins and the suprarenal vein (so-called gastric-renal shunt). Concomitant collaterals such as EV, para-esophageal vein, and para-umbilical vein were also observed in nearly 60% of FV. Endoscopic injection sclerotherapy (EIS) with Histoacryl is thought to be the most approved treatment for hemorrhage from FV, but repeated treatment for residual FV and care for ensuing hepatic failure are required. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a notable interventional radiological procedure specially developed for the elective or prophylactic treatment of FV. If the procedure is technically successful, long-term eradication of treated FV is found in most patients without recurrence. B-RTO includes another significance, obliteration of the unified portal-systemic shunt. Follow-up abdominal CT scan revealed a high incidence of long-term obliteration of the gastric-renal shunt after B-RTO. Benefits such as elevation of serum albumin, improvement in 15-min retention rate of indocyanine green, decrease in blood ammonia levels, and improvement of encephalopathy are sometimes observed. [source]


    Endoscopic Injection Sclerotherapy for the Treatment of Recurrent Esophageal Varices after Esophageal Transection

    DIGESTIVE ENDOSCOPY, Issue 3 2002
    Hiroshi Yoshida
    Background: ,We examined the hemodynamic changes associated with recurrent esophageal varices after esophageal transection (ET) and evaluated the effectiveness of endoscopic injection sclerotherapy (EIS) as the treatment for these varices. Methods: ,Nineteen patients with recurrent esophageal varices after ET were treated by EIS. Endoscopic varicealography during injection sclerotherapy, following oral blockage of flow by a balloon, identified three patterns: (i) type 1: common type, continuous filling by the feeder vessel of the varix; (ii) type 2: retrograde-disappearing type, confirmed hepatofugal flow; and (iii) type 3: immediate washout type, immediate washout of contrast medium. Results: ,Angiography revealed that the hepatofugal feeder vessel was the right gastric vein in all cases. Fourteen patients (73.7%) were classified as type 1, 4 patients (21.1%) as type 2, and 1 patient (5.3%) as type 3. Fewer treatment sessions were required in type 1 than in type 2 (P < 0.005). Recurrent varices were completely eradicated in all patients except the patient with type 3 disease. Cumulative re-recurrence rates at 5 and 10 years were similar for types 1 and 2 (28.6 and 71.4%vs 25 and 25%, respectively). The cumulative survival rates after EIS at 5 and 10 years were also similar for types 1 and 2 (77.1 and 66.1%vs 66.7 and 66.7%). Conclusion: ,Endoscopic injection sclerotherapy is an effective treatment for recurrent esophageal varices after ET, except in type 3 disease. Our classification based on endoscopic varicealography during injection sclerotherapy provides knowledge of blood flow within the varices that helps to inform the treatment strategy. [source]


    Noninvasive Diagnosis of Large Esophageal Varices by Fibroscan: Strong Influence of the Cirrhosis Etiology

    ALCOHOLISM, Issue 7 2010
    Eric Nguyen-Khac
    Background:, Large esophageal varices (LOV) were diagnosed by endoscopy in patients with cirrhosis. Noninvasive method would be valuable. Aims:, To evaluate the diagnostic performance of Fibroscan for LOV prediction and to investigate the prognostic value of liver stiffness (LS) in cirrhosis. Patients and Methods:, One hundred and eighty-three patients with cirrhosis (103 alcohol, 58 viral, and 22 others) underwent an endoscopy and a Fibroscan. Of those patients, 41 (22.4%) had LOV. Results:, Median LS was 33.66 kPa (range: 12,75), higher in patients with LOV than those without (51.24 ± 1.61 vs. 29.81 ± 1.82 kPa, p < 0.0001), and in alcoholic than nonalcoholic (40.39 ± 1.75 vs. 25.73 ± 1.82, p < 0.0001). In whole population, a LS ,48 kPa predicted LOV with sensitivity, specificity, positive, negative predictive values (PPV, NPV) of 73.2, 73.2, 44.1, and 90.4%, respectively, and an area under ROC curve (AUROC) of 0.75 (CI 95%: 0.69,0.82). For alcoholic cirrhosis, LS was ,47.2 kPa with sensitivity, specificity, PPV, NPV of 84.6, 63.6, 44, and 92.5%, respectively, AUROC 0.77 (0.68,0.85). For viral cirrhosis, a LS ,19.8 kPa generated diagnostic values of 88.9, 55.1, 26.7, and 96.4% and 0.73 (0.60,0.84). Sixteen (8.75%) patients died at 1 year. In multivariate analysis, LS was not predictive of mortality. Conclusions:, Etiology of cirrhosis has strong impact on LS cutoff for diagnosis of LOV. Studies should be performed with homogenous cirrhosis etiology. [source]


    Esophageal Varices due to a Probable Arteriovenous Communication in a Dog

    JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 6 2007
    Giovanna Bertolini
    First page of article [source]


    Melanin-associated pigmented lesions of the oral mucosa: presentation, differential diagnosis, and treatment

    DERMATOLOGIC THERAPY, Issue 3 2010
    Susan Müller
    ABSTRACT Intraoral pigmentation is quite common and has numerous etiologies, ranging from exogenous to physiological to neoplastic. Many pigmented lesions of the oral cavity are associated with melanin pigment. The differential diagnosis of mucosal pigmented lesions includes hematomas, varices, and petechiae which may appear to be pigmented. Unlike cutaneous melanomas, oral melanomas are diagnosed late and have a poor prognosis regardless of depth of invasion. As such, the clinical presentation and treatment of intraoral melanoma will be discussed. Developing a differential diagnosis is imperative for a clinician faced with these lesions in order to appropriately treat the patient. This article will focus on the most common oral melanocytic lesions, along with mimics. [source]


    GENERAL RULES FOR RECORDING ENDOSCOPIC FINDINGS OF ESOPHAGOGASTRIC VARICES (2ND EDITION)

    DIGESTIVE ENDOSCOPY, Issue 1 2010
    Takashi Tajiri
    General rules for recording endoscopic findings of esophageal varices were initially proposed in 1980 and revised in 1991. These rules have widely been used in Japan and other countries. Recently, portal hypertensive gastropathy has been recognized as a distinct histological and functional entity. Endoscopic ultrasonography can clearly depict vascular structures around the esophageal wall in patients with portal hypertension. Owing to progress in medicine, we have updated and slightly modified the former rules. The revised rules are simpler and more straightforward than the former rules and include newly recognized findings of portal hypertensive gastropathy and a new classification for endoscopic ultrasonographic findings. [source]


    Splenic infarction: rare complication of N -butyl-2-cyanoacrylate injection for gastric varices

    DIGESTIVE ENDOSCOPY, Issue 1 2010
    Mevlut Kurt
    No abstract is available for this article. [source]


    HEMODYNAMIC MECHANISM OF ESOPHAGEAL VARICES

    DIGESTIVE ENDOSCOPY, Issue 1 2006
    Katsutoshi Obara
    We investigated the correlation between the collaterals around the esophagus and recurrence of esophageal varices in patients with portal hypertension who had undergone endoscopic injection sclerotherapy (EIS). In patients with portal hypertension, many types of collaterals around the esophagus were visualized by endoscopic ultrasonography (EUS). The collaterals outside the esophageal wall detected by EUS were divided into two groups according to the location of the veins: peri-esophageal collateral veins (peri-ECV) and para-esophageal collateral veins (para-ECV) Perforating veins are those that have penetrated the esophageal wall and have connected with either peri-ECV or para-ECV. We demonstrated that severe peri-ECV and large perforating veins play an important role in the development of esophageal varices in untreated patients with portal hypertension. The results of our investigation have shown that detection of peri-ECV and perforating veins by EUS and treatment of them by EIS appears to be important for the treatment of esophageal varices. The disappearance of peri-ECV by EIS is essential for reducing the recurrence rate of esophageal varices. To prevent variceal recurrence, a mucosal fibrosing method using argon plasma coagulation has been widely performed in Japan. If EUS abnormalities are associated with variceal recurrence, we recommend the use of the mucosal fibrosing method. In conclusion, the presence of severe peri-ECV and large perforating veins in the esophageal wall strongly correlate with the recurrence of esophageal varices in patients with portal hypertension. An understanding of these EUS abnormalities on the basis of hemodynamics around the esophagus is important for the management of esophageal varices in patients with portal hypertension. [source]


    GASTRIC FUNDIC VARICES: HEMODYNAMICS AND NON-SURGICAL TREATMENT

    DIGESTIVE ENDOSCOPY, Issue 3 2005
    Seishu Hayashi
    The hemodynamics and non-surgical treatment of gastric fundic varices (FV) are reviewed. FV are more frequently supplied by the short and posterior gastric veins than esophageal varices (EV), and are formed mostly by large spontaneous shunts in which the gastric or splenic vein is continuous with the left renal vein via the inferior phrenic veins and the suprarenal vein (so-called gastric-renal shunt). Concomitant collaterals such as EV, para-esophageal vein, and para-umbilical vein were also observed in nearly 60% of FV. Endoscopic injection sclerotherapy (EIS) with Histoacryl is thought to be the most approved treatment for hemorrhage from FV, but repeated treatment for residual FV and care for ensuing hepatic failure are required. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a notable interventional radiological procedure specially developed for the elective or prophylactic treatment of FV. If the procedure is technically successful, long-term eradication of treated FV is found in most patients without recurrence. B-RTO includes another significance, obliteration of the unified portal-systemic shunt. Follow-up abdominal CT scan revealed a high incidence of long-term obliteration of the gastric-renal shunt after B-RTO. Benefits such as elevation of serum albumin, improvement in 15-min retention rate of indocyanine green, decrease in blood ammonia levels, and improvement of encephalopathy are sometimes observed. [source]


    Endoscopic Injection Sclerotherapy for the Treatment of Recurrent Esophageal Varices after Esophageal Transection

    DIGESTIVE ENDOSCOPY, Issue 3 2002
    Hiroshi Yoshida
    Background: ,We examined the hemodynamic changes associated with recurrent esophageal varices after esophageal transection (ET) and evaluated the effectiveness of endoscopic injection sclerotherapy (EIS) as the treatment for these varices. Methods: ,Nineteen patients with recurrent esophageal varices after ET were treated by EIS. Endoscopic varicealography during injection sclerotherapy, following oral blockage of flow by a balloon, identified three patterns: (i) type 1: common type, continuous filling by the feeder vessel of the varix; (ii) type 2: retrograde-disappearing type, confirmed hepatofugal flow; and (iii) type 3: immediate washout type, immediate washout of contrast medium. Results: ,Angiography revealed that the hepatofugal feeder vessel was the right gastric vein in all cases. Fourteen patients (73.7%) were classified as type 1, 4 patients (21.1%) as type 2, and 1 patient (5.3%) as type 3. Fewer treatment sessions were required in type 1 than in type 2 (P < 0.005). Recurrent varices were completely eradicated in all patients except the patient with type 3 disease. Cumulative re-recurrence rates at 5 and 10 years were similar for types 1 and 2 (28.6 and 71.4%vs 25 and 25%, respectively). The cumulative survival rates after EIS at 5 and 10 years were also similar for types 1 and 2 (77.1 and 66.1%vs 66.7 and 66.7%). Conclusion: ,Endoscopic injection sclerotherapy is an effective treatment for recurrent esophageal varices after ET, except in type 3 disease. Our classification based on endoscopic varicealography during injection sclerotherapy provides knowledge of blood flow within the varices that helps to inform the treatment strategy. [source]


    A study comparing tolerability, satisfaction and acceptance of three different techniques for esophageal endoscopy: sedated conventional, unsedated peroral ultra thin, and esophageal capsule

    DISEASES OF THE ESOPHAGUS, Issue 5 2009
    G. Nakos
    SUMMARY Three methods of esophagoscopy are available until now: sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. The three methods carry comparable diagnostic accuracy and different complication rates. Although all of them have been found well accepted from patients, no comparative study comprising the three techniques has been published. The aim of this study was to compare the three methods of esophagoscopy regarding tolerability, satisfaction, and acceptance. Twenty patients with large esophageal varices and 10 with gastroesophageal reflux disease were prospectively included. All patients underwent consecutively sedated conventional endoscopy, unsedated ultrathin endoscopy, and esophageal capsule endoscopy. After each procedure, patients completed a seven-item questionnaire. The total positive attitude of patients toward all methods was high. However, statistical analysis revealed the following differences in favor of esophageal capsule endoscopy: (i) total positive attitude has been found higher (,2= 18.2, df = 2, P= 0.00), (ii) less patients felt pain (,2= 6.9, df = 2, P= 0.03) and discomfort (,2= 22.1, df = 2, P= 0.00), (iii) less patients experienced difficulty (,2= 13.7, df = 2, P= 0.01), and (iv) more patients were willing to undergo esophageal capsule endoscopy in the future (,2= 12.1, df = 2, P= 0.002). Esophageal capsule endoscopy was characterized by a more positive general attitude and caused less pain and discomfort. Sedated conventional endoscopy has been found more difficult. More patients would repeat esophageal capsule endoscopy in the future. Patients' total position for all three available techniques for esophageal endoscopy was excellent and renders the observed advantage of esophageal capsule endoscopy over both sedated conventional and unsedated ultrathin endoscopy a statistical finding without a real clinical benefit. [source]


    Sustained virologic response prevents the development of esophageal varices in compensated, Child-Pugh class A hepatitis C virus,induced cirrhosis.

    HEPATOLOGY, Issue 6 2010
    A 12-year prospective follow-up study
    The incidence of de novo development of esophageal varices (EV) in patients with compensated liver cirrhosis has been determined by few studies in the short term and never in the long term. The aims of the present study were to determine the incidence and the risk factors associated with the development of EV and to assess whether antiviral treatment and achievement of sustained virologic response (SVR) may prevent de novo EV development in patients with HCV-induced cirrhosis. We studied 218 patients with compensated EV-free, HCV-induced cirrhosis consecutively enrolled between 1989 and 1992 at three referral centers in Milan, Italy. Endoscopic surveillance was performed at 3-year intervals according to international guidelines. SVR was defined as undetectable serum HCV-RNA 24 weeks after treatment discontinuation. During a median follow-up of 11.4 years, 149/218 (68%) patients received antiviral treatment and 34 (22.8%) achieved SVR. None of the SVR patients developed EV compared with 22 (31.8%) of the 69 untreated subjects (P < 0.0001) and 45 (39.1%) of the 115 non-SVR patients (P < 0.0001). On multivariate analysis, HCV genotype 1b (hazard ratio [HR] 2.40; 95% confidence interval [CI] 1.17-4.90) and baseline model for end-stage liver disease (MELD) score (HR 1.20; 95% CI 1.07-1.35 for 1 point increase) were independent predictors of EV. Conclusion: In the long term, the achievement of SVR prevents the development of EV in patients with compensated HCV-induced cirrhosis. Therefore, in these patients, endoscopic surveillance can be safely delayed or avoided. Genotype 1b infection and MELD score identify the subset of patients at higher risk of EV development who need tailored endoscopic surveillance. Hepatology 2010 [source]


    Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis,

    HEPATOLOGY, Issue 1 2008
    Amir A. Qamar
    Current guidelines recommend esophagogastroduodenoscopy (EGD) in patients with cirrhosis to screen for gastroesophageal varices (GEV). Thrombocytopenia has been proposed as a noninvasive test to predict the presence of GEV. There is no agreement regarding a specific platelet count (PLT) that can reliably predict GEV. The present longitudinal study aims to (1) further investigate the relationship between varices and PLT at the time of endoscopy, (2) investigate whether changes in PLT from the baseline over time can predict the development of GEV, and (3) investigate whether changes in PLT correlate with the hepatic venous pressure gradient (HVPG). A secondary analysis was conducted for 213 subjects with compensated cirrhosis with portal hypertension but without GEV enrolled in a randomized, placebo-controlled, double-blind trial of a nonselective beta-blocker used to prevent GEV. PLTs were obtained every 3 months, and HVPG measurements and EGD were done annually. The PLTs were compared between subjects who did and did not develop GEV. In a median follow-up of 54.9 months, 84 patients developed GEV. PLT was greater than 150,000 in 15% of patients at the development of GEV. A receiver operating curve did not show any PLT with high sensitivity or specificity for the presence of GEV. Subjects with clinically insignificant portal hypertension (HVPG < 10 mm Hg) whose PLT remained greater than 100,000 had a 2-fold reduction in the occurrence of GEV (P = 0.0374). A significant correlation was found between HVPG and PLT at the baseline, year 1, and year 5 (P < 0.0001). Conclusion: Cross-sectional or longitudinal evaluations of PLTs are inadequate noninvasive markers for GEV. Patients with mild portal hypertension whose PLT remains greater than 100,000 have significantly less risk of GEV. Although HVPG correlates somewhat with PLT, changes in PLT cannot be used as a surrogate for HVPG changes. (HEPATOLOGY 2008;47:153,159.) [source]


    Noninvasive markers of esophageal varices: Another round, not the last,

    HEPATOLOGY, Issue 1 2004
    Gennaro D'Amico
    First page of article [source]


    Propranolol plus placebo versus propranolol plus isosorbide-5-mononitrate in the prevention of a first variceal bleed: A double-blind RCT

    HEPATOLOGY, Issue 6 2003
    Juan Carlos García-Pagán M.D.
    Nonselective ,-blockers are very effective in preventing first variceal bleeding in patients with cirrhosis. Treatment with isosorbide-5-mononitrate (IS-MN) plus propranolol achieves a greater reduction in portal pressure than propranolol alone. The present multicenter, prospective, double-blind, randomized, controlled trial evaluated whether combined drug therapy could be more effective than propranolol alone in preventing variceal bleeding. A total of 349 consecutive cirrhotic patients with gastroesophageal varices were randomized to receive propranolol + placebo (n = 174) or propranolol + IS-MN (n = 175). There were no significant differences in the 1- and 2-year actuarial probability of variceal bleeding between the 2 groups (propranolol + placebo, 8.3% and 10.6%; propranolol + IS-MN, 5% and 12.5%). The only independent predictor of variceal bleeding was a variceal size greater than 5 mm. However, among patients with varices greater than 5 mm (n = 196), there were no significant differences in the incidence of variceal bleeding between the 2 groups. Survival was also similar. Adverse effects were significantly more frequent in the propranolol + IS-MN group due to a greater incidence of headache. There were no significant differences in the incidence of new-onset or worsening ascites or in impairment of renal function. In conclusion, propranolol effectively prevents variceal bleeding. Adding IS-MN does not further decrease the low residual risk of bleeding in patients receiving propranolol. However, the long-term use of this combination drug therapy is safe and may be an alternative in clinical conditions associated with a greater risk of bleeding. [source]


    Low doses of isosorbide mononitrate attenuate the postprandial increase in portal pressure in patients with cirrhosis

    HEPATOLOGY, Issue 2 2003
    Lia Bellis
    Postprandial hyperemia is associated with a significant increase in portal pressure in cirrhosis, which may contribute to progressive dilation and rupture of gastroesophageal varices. In cirrhosis, an insufficient hepatic production of nitric oxide (NO) may impair the expected hepatic vasodilatory response to increased blood flow, further exaggerating the postprandial increase in portal pressure. This study was aimed at investigating whether low doses of an oral NO donor might counteract the postprandial peak in portal pressure. Twenty-three portal hypertensive cirrhotics, 8 of them under propranolol therapy, were randomized to receive orally 5-isosorbide mononitrate (ISMN; 10 mg; n = 11) or placebo (n = 12) and a standard liquid meal 15 minutes later. Hepatic venous pressure gradient (HVPG), mean arterial pressure (MAP), and hepatic blood flow (HBF) were measured at baseline and 15, 30, and 45 minutes after a meal. ISMN significantly attenuated the postprandial increase in portal pressure as compared with placebo (peak HVPG increase: 2.4 ± 1.4 mm Hg vs. 5.2 ± 2.1 mm Hg, P = .002). Percentual increases in HBF were similar in both groups. MAP decreased slightly in ISMN group (,7.5% ± .5%; P < .01 vs. baseline). These effects were also observed in patients on chronic propranolol therapy. In conclusion, hepatic NO supplementation by low doses of ISMN effectively reduces the postprandial increase of portal pressure in cirrhosis, with only a mild effect on arterial pressure. The same was observed in patients receiving propranolol. Our results suggest that therapeutic strategies based on selective hepatic NO delivery may improve the treatment of portal hypertension. [source]


    Therapy for primary prophylaxis of varices: And, the winner is ,?

    HEPATOLOGY, Issue 2 2003
    Ala I. Sharara M.D.
    No abstract is available for this article. [source]


    Role of cyanoacrylate in the management of bleeding gastric varices

    HEPATOLOGY, Issue 5 2002
    Akio Matsumoto M.D.
    No abstract is available for this article. [source]


    Increasing intra-abdominal pressure increases pressure, volume, and wall tension in esophageal varices

    HEPATOLOGY, Issue 4 2002
    Angels Escorsell
    Many daily activities cause acute elevations of intra-abdominal pressure (IAP). In portal hypertensive cirrhotic patients, increased IAP increases absolute portal pressure and azygos blood flow, suggesting that it may have detrimental consequences at the esophageal varices. The aim of this study was to investigate the effects of increased IAP on variceal pressure, size, and wall tension. Endosonography and a noninvasive endoscopic pressure gauge were used to measure variceal pressure, radius, wall tension, and volume in baseline conditions and after increasing IAP by 10 mm Hg using an inflatable girdle in 14 patients with cirrhosis and esophageal varices. Increasing IAP markedly increased variceal pressure (from 13.3 ± 4.2 to 17.4 ± 4.6 mm Hg; P = .0001) and radius (from 2.9 ± 1.0 to 3.9 ± 1.1 mm; P = .0001). Consequently, wall tension dramatically increased (from 38.7 ± 13.6 to 65.9 ± 23.8 mm Hg · mm, +78%; P = .0001). Variceal volume increased significantly from 1,264 ± 759 to 2,025 ± 1,129 mm3 (P = .0001). In conclusion, in portal hypertensive cirrhotic patients, increases in IAP have deleterious effects on variceal hemodynamics, markedly increasing the volume, pressure, and wall tension of the varices. Increases in IAP may contribute to the progressive dilatation that precedes the rupture of the varices in portal hypertension. [source]


    Endoscopic screening for esophageal varices in cirrhotic patients

    HEPATOLOGY, Issue 2 2002
    Oliviero Riggio M.D.
    No abstract is available for this article. [source]


    The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis

    HEPATOLOGY, Issue 5 2000
    Carlo Merkel
    In the prevention of variceal rebleeding, it is already established that hemodynamic response to drug treatment (decrease in hepatic venous pressure gradient [HVPG] to 12 mm Hg or by >20%) is predictive of clinical effectiveness. In primary prophylaxis very few clinical data are available. We assessed the role of the hemodynamic response to beta-blockers or beta-blockers plus nitrates in predicting clinical efficacy of prophylaxis. A total of 49 cirrhotic patients with varices at risk of bleeding, without prior variceal bleeding, were investigated by hepatic vein catheterization before and after 1 to 3 months of chronic treatment with nadolol or nadolol plus isosorbide mononitrate, and were followed during treatment for up to 5 years. A total of 30 patients (61%) were good hemodynamic responders, and among them in 12 (24%) HVPG was ,12 mm Hg during treatment. During treatment 9 patients had variceal bleeding: 7 were poor responders and 2 were good responders. The probability of bleeding at 3 years of follow-up was significantly higher in poor responders (41%) than in good responders (7%; P = .0008). No patient reaching an HVPG of 12 mm Hg or less during treatment had variceal bleeding during follow-up. Cox's regression analysis showed that poor hemodynamic response was the main factor predicting bleeding (, = 1.91; SE(,) = 0.80; P = .01). During follow-up 11 patients died of hepatic causes. Survival was related to Child-Pugh class and to initial value of HVPG, according to Cox's analysis. In conclusion, the assessment of hemodynamic response to drugs in terms of HVPG is the best predictor of efficacy of prophylaxis of variceal bleeding in patients treated with beta-blockers or beta-blockers plus nitrates. [source]


    Current status of ectopic varices in Japan: Results of a survey by the Japan Society for Portal Hypertension

    HEPATOLOGY RESEARCH, Issue 8 2010
    Norihito Watanabe
    Aim:, The Clinical Research Committee of the Japan Society for Portal Hypertension has conducted a nationwide questionnaire survey to clarify the current status of ectopic varices in Japan. Methods:, A total of 173 cases of ectopic varices were collected. Results:, Duodenal varices were found in 57 cases, and most of them were located in the descending to transverse parts. There were 11 cases of small intestinal varices and 6 cases of colonic varices, whereas 77 patients had rectal varices, accounting for the greatest proportion (44.5%). Other sites of varices were the biliary tract, anastomotic sites, the stoma, and the diaphragm. Liver cirrhosis was the most frequent diseases (80.3%) underlying ectopic varices. It was noted that patients with rectal varices frequently had a history of esophageal varices (94.8%) and received endoscopic treatment (87.0%). The treatments for ectopic varices were as an emergency in 46.5%, elective in 35.4% and prophylactic in 18.2%. In emergency cases, endoscopic therapy was most frequent (67.4%), followed by interventional radiology (IVR; 15.2%), and endoscopy-IVR combination (6.5%). Elective treatment was performed by endoscopy in 34.3%, IVR in 28.6%, combined endoscopy-IVR in 5.7%, and surgical operation in 25.7%. The prophylactic treatment was endoscopic in 50.0%, IVR in 33.3%, combined treatments in 11.1%, and prophylactic surgery in none. The change of ectopic varices after treatment was disappearance in 54.9%, remnant in 35.4% and recurrence in 9.7%. The rate of disappearance was significantly lower in rectal varices (40.8%) than in duodenal varices (73.4%). The patient outcome did not differ among the various sites of the lesion. Conslusions:, Current status of ectopic varices in Japan has been clarified by a nationwide questionnaire survey. The authors expect that the pathophysiology of ectopic varices will be further elucidated, and that improved diagnostic modalities and treatment methods are established in the future. [source]


    Recent role of splenectomy in chronic hepatic disorders

    HEPATOLOGY RESEARCH, Issue 12 2008
    Toru Ikegami
    For years splenectomy in hepatic disorders has been indicated only for the treatment of gastro-esophageal varices. However, with recent advances in medical and surgical treatments for chronic hepatic disorders, the use of splenectomy has been greatly expanded, such that splenectomy is used for reversing hypersplenism, for applying interferon treatment for hepatitis C, for treating hyperdynamic portal circulation associated with intractable ascites, and for controlling portal pressure during small grafts in living donor liver transplantation. Such experiences have shown the importance of portal hemodynamics, even in cirrhotic livers. Recent advances in surgical techniques have enabled surgeons to perform splenectomy more safely and less invasively, but the procedure still has considerable clinical outcomes. Splenectomy in hepatic disorders may become a more common procedure with expanded indications. However, it should also be noted that the long-term effects of splenectomy, in terms of improved hematological or hepatic function, is still not guaranteed. Moreover, the impact of splenectomy on immunologic status remains unclear and needs to be elucidated in both experimental and clinical settings. [source]


    Natural history of primary biliary cirrhosis

    HEPATOLOGY RESEARCH, Issue 7 2008
    Masanori Abe
    The natural history of primary biliary cirrhosis (PBC) has improved significantly over the last two decades. Most patients are diagnosed with asymptomatic PBC (a-PBC). The prognosis of a-PBC is usually better than that of symptomatic PBC (s-PBC). Among a-PBC patients, some remain asymptomatic, whereas others progress to s-PBC. The prognosis of s-PBC is still poor and the main cause of death in PBC is liver failure. Other complications, such as esophageal varices and hepatocellular carcinoma, also affect the prognosis of PBC patients. Ursodeoxycholic acid treatment improves the prognosis of PBC patients in the early stage. There seems to be several types of PBC progression. [source]


    Portal vein thrombosis in ulcerative colitis complicated by bleeding from gastric varices

    INFLAMMATORY BOWEL DISEASES, Issue 3 2007
    Julia Palkovits MD
    No abstract is available for this article. [source]


    Unusual hepatic-portal-systemic shunting demonstrated by Doppler sonography in children with congenital hepatic vein ostial occlusion

    JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2004
    Maha Barakat MD
    Abstract Purpose This report describes unusual changes in the hepatic vasculature in 3 children presenting with upper gastrointestinal hemorrhage. Methods The study included 3 children (ages 5,8 years) who presented with hematemesis. All had mild hepatosplenomegaly and normal liver function. Esophageal varices were demonstrated in all on upper endoscopy. Color and spectral Doppler sonography was performed to assess the hepatic vasculature, including the hepatic veins (HVs), portal vein (PV), hepatic artery (HA), and inferior vena cava (IVC). Results The HVs were all patent but with ostial occlusion at the point of their communication with the IVC. Complete flow reversal was shown inside the HVs, with blood draining into collateral vessels at the liver surface and paraumbilical vein. In one patient, the paraumbilical vein could be traced to its communication with the right external iliac vein. In all children, the direction of flow in the PV, HA, and IVC was normal. After endoscopic sclerotherapy, all children were shown to be in good general condition and to have normal liver function for a follow-up period of 15,36 months. Conclusions Ostial occlusion of the HV is a rare cause of hepatic outflow obstruction in children. Doppler sonography is a valuable, noninvasive imaging technique for evaluation of the hepatic vasculature and the accompaning shunting pathways in such cases. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:172,178, 2004; Published online in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/jcu.20019 [source]


    Preliminary assessment of miniprobe sonography in the diagnosis of gastric varices and evaluation of treatment with Histoacryl

    JOURNAL OF DIGESTIVE DISEASES, Issue 1 2001
    Zhu Qi
    OBJECTIVE: In comparison with conventional endoscopy, the clinical value of miniprobe sonography (MPS) was assessed both in the diagnosis of gastric varices (GV) and in the evaluation of its treatment with the tissue adhesive agent Histoacryl. METHODS: Twelve patients with liver cirrhosis and portal hypertension caused by hepatitis B in nine cases and hepatitis C in three cases were examined by MPS to verify the presence of gastric fundic varices before and after endoscopic treatment with Histoacryl. Curative efficacy of Histoacryl treatment was defined by the finding of variceal lumen obliteration characteristics in the ultrasonic image. RESULTS: Gastric fundic varices were detected in 10 patients by using MPS, however, only seven cases were detected by using conventional macroscopic examination. For gastric fundic varices, the diagnostic accuracies of standard endoscopy and MPS were 75% (9/12) and 100% (12/12), respectively. Furthermore, MPS was able to produce a practical ultrasonic image of complete or incomplete variceal vessel lumen obliteration for use in the assessment of the efficacy of endoscopic treatment with Histoacryl. CONCLUSIONS: Miniprobe sonography was found to be significantly superior to conventional macroscopic diagnosis in both the detection of fundic varices and the evaluation of the efficacy of endoscopic therapy. Moreover, MPS could play an important role in follow up and in evaluation of the need for further treatment. Therefore, MPS appears to be a safe and very useful clinical technique in evaluating patients with portal hypertension with respect to the detection of fundic varices and may help in selecting patients for appropriate therapy. [source]


    Nasogastric Aspiration and Lavage in Emergency Department Patients with Hematochezia or Melena Without Hematemesis

    ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
    Nicholas Palamidessi MD
    Abstract Objectives:, The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding? Methods:, MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for inclusion in the review if the authors had performed nasogastric aspiration (with or without lavage) in all patients with hematochezia or melena and performed esophagogastroduodenal endoscopy (EGD) in all patients. Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). The outcome was identifying upper GI hemorrhage (active bleeding or high-risk lesions potentially responsible for hemorrhage) and the rate of complications associated with the nasogastric tube insertion. Quality of the included studies was assessed using standard criteria for diagnostic accuracy studies. Results:, Three retrospective studies met our inclusion and exclusion criteria. The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. According to the included studies, the diagnostic performance of the nasogastric aspiration and lavage for predicting upper GI bleeding is poor. The sensitivity of this test ranged from 42% to 84%, the specificity from 54% to 91%, and negative likelihood ratios from 0.62 to 0.20. Only one study reported the rate complications associated with nasogastric aspiration and lavage (1.6%). Conclusions:, Nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis. ACADEMIC EMERGENCY MEDICINE 2010; 17:126,132 © 2010 by the Society for Academic Emergency Medicine [source]