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Esophageal Varices-I: Introduction01:24

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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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Esophageal Varices-II: Clinical Features and Management01:28

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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Psychoneuroimmunology (PNI) is a multidisciplinary field that examines how psychological factors, particularly stress, interact with the immune system and impact physical health. Research in PNI has shown that chronic or traumatic stress can disrupt both the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. These disruptions contribute to serious health conditions, including cardiovascular diseases.
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Cardiac biomarkers are critical in diagnosing, prognosing, and managing cardiovascular diseases. Routine measurement of specific biomarkers such as B-type natriuretic peptide (BNP), C-reactive protein (CRP), and homocysteine (Hcy) is common practice in clinical settings to evaluate heart function and predict cardiovascular events.
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Introduction
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Peptic Ulcer Disease I: Introduction01:30

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Related Experiment Video

Updated: Jul 7, 2025

Measurement of the Hepatic Venous Pressure Gradient and Transjugular Liver Biopsy
07:10

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Low Urinary Free Cortisol as a Risk Factor for Patients with Variceal Bleeding.

Ioanna Aggeletopoulou1, Efthymios P Tsounis1, Maria Kalafateli1

  • 1Division of Gastroenterology, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece.

Medicina (Kaunas, Lithuania)
|December 23, 2023
PubMed
Summary

Low 24-hour urinary free cortisol (UFC) may indicate a higher risk for patients with liver cirrhosis and variceal bleeding. Further research is needed to confirm UFC as a reliable index for adrenal cortisol production in this patient group.

Keywords:
24 h UFC24 h urinary free cortisol5-day treatment failure6-week mortalitydecompensationliver cirrhosisvariceal bleeding

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Area of Science:

  • Endocrinology
  • Hepatology
  • Clinical Chemistry

Background:

  • Current cortisol assessment methods have limitations in accurately diagnosing relative adrenal insufficiency.
  • Free cortisol assays are more accurate but impractical for routine clinical use due to cost and time.
  • Alternative methods like salivary cortisol and indirect measurements are being explored.

Purpose of the Study:

  • To investigate correlations between 24-hour urinary free cortisol (UFC), free plasma cortisol, serum total cortisol, and salivary cortisol in variceal bleeding.
  • To evaluate the predictive value of UFC for mortality and treatment failure in liver cirrhosis patients with variceal bleeding.

Main Methods:

  • 40 outpatients with liver cirrhosis and variceal bleeding were studied.
  • Free cortisol was measured in serum, saliva, and urine using electrochemiluminescence immunoassay.
  • Plasma-free cortisol was quantified using a single quadrupole mass spectrometer.

Main Results:

  • UFC showed significant correlation with free plasma cortisol.
  • UFC negatively correlated with Child-Pugh (CP) score and C-reactive protein (CRP) levels.
  • Low UFC levels were associated with rebleeding, infection, death, and higher mortality risk in CP stage C patients.

Conclusions:

  • Low UFC levels may be a risk factor in patients with liver cirrhosis and variceal bleeding.
  • UFC's potential as an index for adrenal cortisol production in variceal bleeding requires further investigation.