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Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively
M Rabinovitz1, Y K Yoo, R R Schade
1Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania 15261.
Insights
Cirrhosis patients undergoing liver transplant evaluation show varying endoscopic findings. Gastritis is more common in parenchymal liver disease, while other bleeding lesions like varices are similar across cirrhosis types.
Area of Science:
- Hepatology
- Gastroenterology
- Transplantation Medicine
Background:
- Upper gastrointestinal hemorrhage is a critical complication and cause of mortality in cirrhosis patients.
- Key bleeding sources include esophageal varices, gastritis, and peptic ulcers.
Purpose of the Study:
- To investigate the prevalence of endoscopic findings, including potential bleeding lesions, in cirrhotic patients evaluated for orthotopic liver transplantation (OLTx).
- To compare endoscopic findings between patients with parenchymal liver disease and cholestatic liver disease.
Main Methods:
- Upper gastrointestinal endoscopy was performed on 510 consecutive cirrhotic patients.
- Patients were categorized into parenchymal liver disease (n=319) and cholestatic liver disease (n=191) groups.
- Endoscopic findings were analyzed, correlating with disease severity (Pugh-Child's criteria) and clinical signs like ascites and encephalopathy.
Main Results:
- Gastritis occurred significantly more frequently in the parenchymal liver disease group (49.8%) compared to the cholestatic group (30.9%).
- Prevalence of esophagitis, varices, and peptic ulcers was similar between the two groups.
- Ascites and encephalopathy were more common in parenchymal liver disease. Esophageal varices prevalence increased with disease severity in both groups.
Conclusions:
- While gastritis prevalence differs, common bleeding lesions like varices and ulcers are similarly distributed across etiologies of cirrhosis in OLTx candidates.
- Endoscopic evaluation is crucial for identifying potential bleeding risks in cirrhotic patients, irrespective of liver disease type.
- Disease severity, indicated by Pugh-Child's criteria, correlates with the presence of esophageal varices.
Abstract:
Upper gastrointestinal hemorrhage is one of the more important complications of cirrhosis and a major cause of death in such patients. The main sites of bleeding are esophageal varices, gastritis, and peptic ulcers. In order to determine the prevalence of either potential bleeding lesions or of other endoscopic findings in hemodynamically stable individuals with various etiologies of cirrhosis, 510 consecutive cirrhotic patients, evaluated for possible orthotopic liver transplantation (OLTx) underwent an upper gastrointestinal endoscopy for combined diagnostic and therapeutic purposes. The patients were divided into two main groups: 319 patients with parenchymal liver disease and 191 patients with cholestatic liver disease. Gastritis was found significantly more often in patients with parenchymal liver disease than in those with cholestatic liver disease (49.8% vs 30.9%; P less than 0.001). In contrast, the prevalence of esophagitis, esophageal and gastric varices, gastric ulcer, duodenal ulcer, and duodenitis was similar in both groups. Normal endoscopic findings were present in 5.0% of the parenchymal group and 11.5% of the cholestatic group (P less than 0.02). Ascites and encephalopathy were found significantly more often in subjects with parenchymal liver disease as compared to those with cholestatic liver disease. Portal hypertension and its degree, as assessed by the presence and size of esophageal varices, was similar in both groups, and in both groups there was a statistically significant qualitative trend of increasing prevalence of esophageal varices with increasing severity of disease as estimated using Pugh-Child's criteria.