scholarly journals Portal Hypertensive Polyps as Gastroscopic Finding in Liver Cirrhosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Firdevs Topal ◽  
Sabiye Akbulut ◽  
Cengiz Karahanlı ◽  
Süleyman Günay ◽  
Elif Sarıtaş Yüksel ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Polypoid Lesion ◽  
Healthy Control Group ◽  
Control Group ◽  
Esophageal Variceal ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Healthy Control ◽  
Upper Gi Endoscopy

Background. Portal hypertensive polyps in patients with portal hypertension are described. Aims. The most significant and serious complication in liver cirrhosis proves to be portal hypertension. Polypoid lesions, which can be seen in the stomach as endoscopic finding in patients with portal hypertension, have not quite been defined in the literature. The aim of this study, therefore, was to define polypoid lesion formation due to portal hypertension in the upper gastrointestinal system in patients with portal hypertension. Study Design. Cross-sectional study. Methods. The study covered a group of patients with liver cirrhosis and a healthy control group that did not have portal hypertension. All individuals covered by the study received upper GI endoscopy, while the endoscopic features and pathological characteristics of the identified polypoid lesions were defined. Standard histological criteria were used in polyp diagnosis. Results. A total of 400 individuals were included in the study. Upper GI endoscopy was performed for 200 patients with liver cirrhosis and another 200 healthy individuals with no portal hypertension in the control group. When the cases were gastroscopically assessed with regard to polypoid lesion presence, it was seen that a total of 87 (21.8%) individuals had polyps. While 67 (33.5%) cirrhotic patients were identified to have polyps, 20 (10%) individuals in the healthy control group had polyps. When the results of those with liver cirrhosis who received esophageal variceal endoscopic band ligation (EVL) and who did not were compared, it was observed that a higher number of individuals in the group with EVL had polypoid lesions. When the patient and control groups were compared as to Helicobacter pylori presence, the results showed that it was slightly higher in the dyspepsia group but the difference was not statistically significant (p>0.05). Conclusion. Portal hypertension-associated polypoid lesions are common in advanced liver cirrhosis cases. The pathological analyses of these polyps pointed out that they were all benign and no malignant cases were detected. It was argued that these polypoid lesions, referred to as portal hypertensive polyps, were associated with elevated angiogenesis in the gastric mucosa.

scholarly journals A comparative study of multi-detector CT portography versus endoscopy in evaluation of gastro-esophageal varices in portal hypertension patients

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Hany El-Assaly ◽  
Lamiaa I. A. Metwally ◽  
Heba Azzam ◽  
Mohamed Ibrahim Seif-Elnasr
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Imaging Modality ◽  
Splenic Vein ◽  
Gastric Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Vein Diameter

Abstract Background Portal hypertension is a major complication resulting from obstruction of portal blood flow, like cirrhosis or portal vein thrombosis, that leads to portal hypertension. MDCT angiography has become an important tool for investigation of the liver as well as potentially challenging varices by detailing the course of these tortuous vessels. This information is decisive for liver transplantation as well as for common procedures in which an unexpected varix can cause significant bleeding. Results This study included an assessment of 60 cases of portal hypertension (28 males and 32 females), their age ranged from 42 to 69 years (mean age = 57.2 ± 6.63). All patients were diagnosed with portal hypertension, underwent upper GI endoscopy followed by a triphasic CT scan with CT angiographic assessment for the screening of gastro-esophageal varices. CT is highly sensitive as compared to upper GI endoscopy (sensitivity 93%) in detecting esophageal varices. Gastric varices detected by CT in 22 patients (37%) compared to 14 patients (23%) detected by endoscopy. While paraesophageal varices were detected in 63% of patients and retro-gastric varices in 80% of patients that were not visualized by endoscopy. Our study reported that the commonest type of collaterals were the splenic collaterals, and we also found there is a significant correlation between the portal vein diameter and the number of collaterals as well as between the portal vein diameter and splenic vein diameter. Conclusions Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices. It also proved that there is a correlation between portal vein diameter, splenic vein diameter, and number of collaterals.

scholarly journals AGREEMENT BETWEEN MULTIDETECTOR COMPUTED TOMOGRAPHY AND ENDOSCOPY FOR THE EVALUATION OF GASTRO-ESOPHAGEAL VARICES IN PATIENTS WITH PORTAL HYPERTENSION.

2021 ◽  
pp. 1-3
Author(s):  
Mehak Garg ◽  
Nirmal Kumar Prabhu ◽  
Shivane Garg ◽  
Saravanan S ◽  
Rubalakshmi S ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Gold Standard ◽  
Gastric Fundus ◽  
Observer Agreement ◽  
Gastroesophageal Varices ◽  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy

Aim: The aim is to study the agreement between MDCT and endoscopy in diagnosing gastroesophageal varices in patients of chronic liver disease with portal hypertension, keeping endoscopy as gold standard. Materials and Methods: The study included 29 cirrhotic patients with portal hypertension assessed between August 2018 to August 2020 who underwent upper gastrointestinal (GI) endoscopy and MDCT within 12 weeks. Two radiologists reviewed the scans, to determine the grade of esophageal varices. To evaluate the accuracy of MDCT findings by Radiologists 1 and 2 with respect to endoscopy findings (GOLD STANDARD), McNemar’s chi square test with validity parameters such as Sensitivity, Specificity, Positive predictive value, Negative predictive value and accuracy was computed. Cohens kappa was used to ascertain the inter-observer agreement for grading of varices between MDCT and endoscopy. Results: The sensitivity of MDCT for radiologist A was 76.7%, specificity 93%, Accuracy 89.7%, PPV 91.6%, NPV 93.9% and for radiologist B, 79%, 93.4%, 89.6%, 81.4% and 93.1% respectively. For the inter-rater agreement the kappa value between Radiologist A v/s upper GI endoscopy was 0.716, Radiologist B v/s upper GI endoscopy was 0.720 and Radiologist A v/s Radiologist B was 0.808. MDCT detected para esophageal varices in 16 cases, gastric fundus varices in 9 cases and splenorenal collaterals in 3 cases, palisade vein dilatation was positive in 9 cases, negative in 20 cases. 3 cases of HCC were incidentally found during examination. Conclusion: MDCT is a good replacement for endoscopy in the detection of gastroesophageal varices, especially those with high grade varices (grade 2 and 3). MDCT helps in detection of palisade vein and other extra-luminal findings like HCC, other portosystemic collaterals.

scholarly journals Can we reduce oxidative stress with liver transplantation?

2021 ◽  
Author(s):  
Mesut Aydin
Keyword(s):  
Oxidative Stress ◽  
Liver Transplantation ◽  
Superoxide Dismutase ◽  
Liver Cirrhosis ◽  
Reduced Glutathione ◽  
Healthy Control Group ◽  
Control Group ◽  
Oxidative Stress Status ◽  
Healthy Control ◽  
Patient Groups

Background: The aim of this study was to determine the levels of lipid peroxidation (MDA) and antioxidants such as reduced glutathione (GSH), catalase (CAT) and superoxide dismutase (SOD) in the blood serum of patients with cirrhosis and liver transplantation. Materials and Methods: In this study, serum malondialdehyde acid (MDA) levels, superoxide dismutase (SOD), reduced glutathione (GSH), and catalase (CAT) activities were measured spectrophotometrically and compared to the results of the healthy control group. Results: SOD, CAT and GSH activities were significantly decreased in the patient groups compared to the healthy control group (p<0.05). MDA levels were significantly higher in the patient group compared to the healthy control group (p <0.05). Conclusion: In conclusion, this study demonstrated that oxidative stress may play an important role in the development of liver cirrhosis and in liver transplantation. This study is the first one to show how MDA, SOD, CAT and GSH levels change in liver cirrhosis and liver transplantation, while further studies are essential to investigate antioxidant enzymes and oxidative stress status in patients with cirrhosis and liver transplantation.

scholarly journals CLINICALAND ENDOSCOPIC PROFILE OF PEPTIC ULCER DISEASE IN LIVER CIRRHOTICS : STUDY AT A LIVER TRANSPLANT CENTRE IN SOUTH INDIA

2020 ◽  
pp. 1-2
Author(s):  
MS Revathy ◽  
Amiya Ranjan ◽  
B. Sumathi ◽  
Manimaran M
Keyword(s):  
Liver Cirrhosis ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Refractory Ascites ◽  
Biliary Cirrhosis ◽  
Gi Endoscopy ◽  
Ulcer Disease ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Cirrhotic Patients

Background: Peptic ulcer disease in patients with liver cirrhosis poses significant morbidity and mortality . It is also a cause for gastrointestinal bleed . Our study aims at providing a clinical and endoscopic profile of peptic ulcer disease in patients suffering from liver cirrhosis . Objective: Providing an insight into the clinical and endoscopic profile of patients suffering from liver cirrhosis and peptic ulcer disease, with special reference to Child Pugh score, spontaneous bacterial peritonitis, refractory ascites and other comorbidities. Methods: This study was conducted in the Department of Medical Gastroenterology, Govt Stanley medical college, Chennai from September 2018 to April 2019. All cirrhotic patients underwent relevant blood investigations, ultrasound abdomen, portal vein doppler and upper GI endoscopy. Gastric ulcers were biopsied according to standard protocol. RUT was not performed in all cases for H.Pylori detection . Results: A total of 361 cirrhotic patients that underwent upper GI endoscopy, 45 patients were incuded in our study based on the inclusion criteria. The prevalence of peptic ulcer disease in liver cirrhotics was 12.4% . Males to females ratio of 38:7. Mean age was 38 years ±2.8. Mean CTP score was 8.42±1.90 . median of 8 , mode 10 . Ascites was noted in 37, SBP in 22 and refractory ascites in 4. Etiology for cirrhosis was alcohol (44.4%) , cryptogenic(17.8%) , hepatitis B(15.6%) , Budd Chiari syndrome(8.9%) , hepatitis C(4.4%), wilsons disease (2.2%) , secondary biliary cirrhosis(2.2%) , autoimmune hepatitis(2.2%) . 23 had CPT score B, followed by CPT C in 15 and CPT A in 7 . Conclusion: In conclusion, a significant proportion of patients with cirrhosis develop PUD. Furthermore, H pylori infection and NSAIDs are not the only, or perhaps even the most important, risk factors for PUD in patients with cirrhosis. These observations have important practical implications for physicians caring for patients with chronic liver disease.

scholarly journals Correlation between Serum-Ascites Albumin Gradient and Esophageal Varices in Portal Hypertension due to Cirrhosis of Liver

2021 ◽  
Vol 4 (1) ◽  
pp. 1-6
Author(s):  
Dinesh Koirala ◽  
Krishna Chandra Devkota ◽  
Ugra Narayan Pathak ◽  
Prabin Adhikari ◽  
Nirmal Ghimire
Keyword(s):  
Portal Hypertension ◽  
Positive Predictive Value ◽  
Esophageal Varices ◽  
Predictive Value ◽  
Cirrhosis Of The Liver ◽  
Gi Endoscopy ◽  
Positive Correlation ◽  
Upper Gi ◽  
Upper Gi Endoscopy ◽  
Cirrhosis Of Liver

Introduction: Cirrhosis of the liver is a major health problem in our country.  Patients with cirrhosis are at risk of developing esophageal varices and variceal bleeding with high mortality. They must undergo routine upper gastrointestinal endoscopy to screen for the presence of varices. This poses an economic, social, and medical burden. Thus, this warrants a non-invasive predictor of esophageal varices in a cirrhotic patient. The aim of this study was to find the correlation between SAAG and esophageal varices in portal hypertension due to cirrhosis of liver. Methods: Patients (45 males and 35 females) above 18 years of age and with cirrhosis of the liver underwent cross sectional observational study at Nepal Medical College Teaching hospital between October 2015 and December 2017 AD. Serum albumin and ascitic fluid albumin were analyzed on the same day and serum-ascites albumin gradient (SAAG) was calculated. Upper GI endoscopy was done to evaluate for the presence of esophageal and gastric varices. Pearson's chi-square test was applied to see the relation between SAAG and esophageal varices.  Results: Among the 80 patients studied, 56.2% were male and  93.75%  had varices. Majority of the patients who had esophageal varices had SAAG of more than 1.1 g/dL. A positive correlation was found between serum-ascites-albumin gradient and esophageal varices but was statistically not significant. A cut-off of  >1.6 for SAAG to discriminate between presence and absence of varices yielded a sensitivity of 78.66% and a positive predictive value of 92.18%. Conclusion: This study highlighted that SAAG has a positive correlation with esophageal varices with high sensitivity and positive predictive value in estimating the presence of varices but without statistical significance. It has a low specificity. Due to statistically insignificant correlation and low specificity, SAAG cannot be used in place of upper GI endoscopy in diagnosing gastroesophageal varices

Vitamin D Treatment in Patients with Hashimoto’s Thyroiditis may Decrease the Development of Hypothyroidism

2016 ◽  
Vol 86 (1-2) ◽  
pp. 9-17 ◽  
Author(s):  
Bekir Ucan ◽  
Mustafa Sahin ◽  
Muyesser Sayki Arslan ◽  
Nujen Colak Bozkurt ◽  
Muhammed Kizilgul ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Hashimoto’S Thyroiditis ◽  
Healthy Control Group ◽  
Hashimoto's Thyroiditis ◽  
Control Group ◽  
Endocrine Society ◽  
Thyroid Autoantibody ◽  
Healthy Control ◽  
The Mean

Abstract.The relationship between Hashimoto’s thyroiditis and vitamin D has been demonstrated in several studies. The aim of the present study was to evaluate vitamin D concentrations in patients with Hashimoto’s thyroiditis, the effect of vitamin D therapy on the course of disease, and to determine changes in thyroid autoantibody status and cardiovascular risk after vitamin D therapy. We included 75 patients with Hashimoto’s thyroiditis and 43 healthy individuals. Vitamin D deficiency is defined as a 25-hydroxy vitamin D (25(OH)D3) concentration less than 20ng/mL. Vitamin D deficient patients were given 50.000 units of 25(OH)D3 weekly for eight weeks in accordance with the Endocrine Society guidelines. All evaluations were repeated after 2 months of treatment. Patients with Hashimoto’s thyroiditis had significantly lower vitamin D concentrations compared with the controls (9.37±0.69 ng/mL vs 11.95±1.01 ng/mL, p < 0.05, respectively). Thyroid autoantibodies were significantly decreased by vitamin D replacement treatment in patients with euthyroid Hashimoto’s thyroiditis. Also, HDL cholesterol concentrations improved in the euthyroid Hashimoto group after treatment. The mean free thyroxine (fT4) concentrations were 0.89±0.02 ng/dL in patients with Hashimoto’s thyroiditis and 1.07±0.03 ng/dL in the healthy control group (p < 0.001). The mean thyroid volumes were 7.71±0.44 mL in patients with Hashimoto’s thyroiditis and 5.46±0.63 mL in the healthy control group (p < 0.01). Vitamin D deficiency is frequent in Hashimoto’s thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

USE OF ROADMAP FLUOROSCOPY IN UPPER GI ENDOSCOPY

2020 ◽  
Author(s):  
J Weigt ◽  
W Elhossary ◽  
W Obst ◽  
P Maciej
Keyword(s):  
Gi Endoscopy ◽  
Upper Gi ◽  
Upper Gi Endoscopy
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