Non-invasive predictors of esophageal varices

Current guidelines recommend screening cirrhotic patients with an endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices. In this study, we aimed at identifying non-endoscopic parameters that could predict the presence and grades of esophageal varices. In a prospective study, 229 newly diagnosed patients with liver cirrhosis, without a history of variceal bleeding, were included. Demographic, clinical, biochemical and ultrasonographic parameters were recorded. Esophageal varices were classified as small and large, at endoscopy. Univariate analysis and multivariate logistic regression analysis were done to identify independent predictors for the presence and grades of varices. Of the 229 patients [141 males; median age 42 years; range 17-73 years] with liver cirrhosis, 97 [42.3%] had small and 81 [35.4%] had large varices. On multivariate analysis, low platelet count [Odd's Ratio [OR], 4.3; 95% confidence interval [CI], 1.2-14.9], Child Pugh class B/C [OR, 3.3; 95% CI, 1.8-6.3], spleen diameter [OR, 4.3; 95% CI, 1.6-11.9] and portal vein diameter [OR, 2.4; 95% CI, 1.1-5.3] were independent predictors for the presence of varices. Likewise, for the presence of large esophageal varices, low platelet count [OR, 2.7; 95% CI, 1.4-5.2], Child Pugh class B/C [OR, 3.8; 95% CI, 2.3-6.5] and spleen diameter [OR, 3.1; 95% CI, 1.6-6.0] were the independent risk factors. The presence and higher grades of varices can be predicted by a low platelet count, Child-Pugh class B/C and spleen diameter. These may be considered as non-endoscopic predictors for the diagnosis and management of large grade varices

Distinguishing tuberculosis and crohn's disease in developing countries: How certain can you be of the diagnosis?

Distinguishing tuberculosis and Crohn's disease in patients presenting with chronic abdominal pain and diarrhea is a huge diagnostic challenge, particularly in tuberculosis endemic countries. A large number of patients with Crohn's disease are initially misclassified as having Intestinal tuberculosis in places where tuberculosis is endemic before they are treated for Crohn's disease. Although a variety of endoscopic, radiological and histological criteria have been recommended for the differentiation, it often proves difficult in routine clinical practice. Future prospective studies are required in patients with granulomatous colitis to prevent unnecessary inappropriate anti tuberculous therapy for patients with Crohn's disease and appropriate early treatment for a patient with tuberculosis