Gastric varices: Classification, endoscopic and ultrasonographic management.

Gastric varices (GV) are responsible for 10-30% of all variceal hemorrhage. However, they tend to bleed more severely with higher mortality. Around 35-90% rebleed after spontaneous hemostasis. Approximately 50% of patients with cirrhosis of liver harbor gastroesophageal varices. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion on classification and pathophysiology of GV.

Cirrhosis histology and Laennec staging system correlate with high portal pressure.

AIMS: To correlate cirrhosis histology and Laennec fibrosis scoring with portal pressure, as determined by hepatic venous pressure gradient (HVPG). METHODS AND RESULTS: One hundred and four patients with biopsy-proven cirrhosis and known HVPG were included in the study. Semiquantitative scoring of 12 histological parameters and quantitative assessment by morphometry for septal thickness and nodule diameter and image analysis for fibrosis were performed. Laennec histological subgrading and clinical staging of cirrhosis were also performed. There were significant positive correlations between HVPG and Laennec histological grade of cirrhosis (P < 0.001), micronodularity (P < 0.001), the presence of thick fibrous septa (P = 0.015), the amount of collagen in the space of Disse (P < 0.001), and the extent of fibrosis by image analysis (P = 0.003). Multivariate analysis, to predict high HVPG (≥16 mmHg), showed that degree of collagen in the space of Disse [P = 0.007, odds ratio (OR) 19.3], histological grade of cirrhosis (P = 0.017, OR 3.9) and micronodularity (P = 0.02, OR 3.5) independently predicted high HVPG. CONCLUSIONS: Histological subclassification of cirrhosis, collagen in the space of Disse and micronodularity are independent predictors of high portal pressure. The Laennec histological subclassification of cirrhosis correlates well with clinical severity of cirrhosis, and can provide useful prognostic information.

Addition of simvastatin to carvedilol non responders: A new pharmacological therapy for treatment of portal hypertension.

AIM: To determine whether addition of simvastatin could be an important pharmacological rescue therapy for carvedilol non-responders. METHODS: One hundred and two consecutive patients of cirrhosis of liver with significant portal hypertension were included. Hepatic venous pressure gradient (HVPG) was measured at the base line and after proper optimization of dose; chronic response was assessed at 3 mo. Carvedilol non-responders were given simvastatin 20 mg per day (increased to 40 mg per day at day 15). Carvedilol plus simvastatin was continued for 1 mo and hemodynamic response was again measured at 1 mo. RESULTS: A total of 102 patients with mean age of 58.3 ± 6.6 years were included. Mean baseline HVPG was 16.75 ± 2.12 mmHg and after optimization of dose and reassessment of HVPG at 3 mo, mean reduction of HVPG from baseline was 5.5 ± 1.7 mmHg and 2.8 ± 1.6 mmHg among responders and non-responders respectively (P < 0.001). Addition of simvastatin to carvedilol non-responders resulted in significant response in 16 patients (42.1%) and thus overall response with carvedilol and carvedilol plus simvastatin was seen in 78 patients (80%). Two patients were removed in chronic protocol study with carvedilol and three patients were removed in carvedilol plus simvastatin study due to side effects. CONCLUSION: Addition of simvastatin to carvedilol non-responders may prove to be an excellent rescue therapy in patients with portal hypertension.