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Abstract
Esophageal varices are found in the majority of patients with liver cirrhosis and portal hypertension. Variceal bleeding is an ominous complication with high mortality rate. Moreover, rebleeding is common without secondary prophylaxis. Endoscopic band ligation is recommended as optimum management. It achieves high eradication rate with no major complications.
Doppler ultrasound is a novel method for assessment of portal hypertension. It has largely replaced the traditional invasive methods, as it allows safe , rapid and noninvasive assessment of blood flow characteristics in the portal circulation.
Gastric mucosal changes are frequently found in portal hypertensive patients. The term ”gastropathy” was preferred as these pathologic changes are characterized by vascular ectasia rather than mucosal inflammation. The exact pathogenesis and natural history of portal hypertensive gastropathy were not elucidated, however, progression of PHG after variceal eradication was reported by several authors. The interruption of variceal blood flow can theoretically lead to aggravation of portal hypertension.
The aim of the present study was to assess the correlation between portal hemodynamic change and portal hypertensive gastropathy before and after endoscopic band ligation of esophageal varices in patients with liver cirrhosis.
The present study was carried out on 20 patients with liver cirrhosis and risky esophageal varices. Patients with hepatocellular carcinoma, on portal pressure reducing drugs, those with portal vein thrombosis or who underwent splenectomy or surgical portosystemic shunts were excluded. Portal hemodynamics and upper GIT endoscopic finding were compared before and one month after variceal eradication by band ligation.
All patients were subjected to: A-Detailed history taking:
With special emphasis on risk factors for liver diseases and history of GIT bleeding. B- Thorough physical examination:
With special emphasis on signs of hepatic insufficiency and local abdominal examination. C- Laboratory investigations:
1- Urine and stool analysis particularly for shistosomal ova.
T A