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A simple noninvasive score predicts gastroesophageal varices in patients with chronic viral hepatitis

Ivan Gentile1, Chiara Viola, Maria Graf

  • 1Department of Public Medicine and Social Security, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy. ivan.gentile@alice.it

Journal of Clinical Gastroenterology
|June 20, 2008
PubMed

Insights

Patients with chronic viral hepatitis and a low-risk score (based on age, platelets, and liver enzymes) are unlikely to have large gastroesophageal varices and may avoid upper endoscopy screening.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Internal Medicine

Background:

  • Guidelines recommend upper endoscopic screening for gastroesophageal varices in cirrhotic patients.
  • Distinguishing cirrhosis from chronic hepatitis can be challenging.

Purpose of the Study:

  • To identify low-risk patients with chronic liver disease who can safely forgo upper endoscopy.
  • To reduce unnecessary endoscopic procedures irrespective of cirrhosis diagnosis.

Main Methods:

  • Evaluated 13 nonendoscopic variables in 254 patients with hepatitis B or C.
  • Utilized logistic regression to identify predictors of esophagogastric varices.
  • Developed a risk score based on age, platelet count, and AST/ALT ratio.

Main Results:

  • 30.3% of patients had varices; 12.2% had large varices.
  • Independent predictors of varices included age >50, platelet count <150,000, albumin <3.6, and AST/ALT ratio >1.
  • A score <2 (based on age, platelets, AST/ALT ratio) identified patients with only small varices (3.2%).

Conclusions:

  • Patients with chronic viral hepatitis and a risk score <2 are unlikely to have large varices.
  • Upper endoscopy can be safely avoided in approximately 50% of patients with this low-risk score.
  • This approach can significantly reduce the need for endoscopic screening in this population.
Abstract

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