Frequency of different types of gastric varices in patients with cirrhosis due to chronic hepatitis C.

OBJECTIVE: To determine the frequency of different types of gastric varices in patients with hepatitis C virus-related cirrhosis. METHODS: The observational cross-sectional study was conducted from August 2014 to August 2015 at Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, using non-probability consecutive sampling. Patients having liver cirrhosis only due to chronic hepatitis C virus, portal vein diameter >12mm or spleen size >12cm in long axis and ascites with no previous history of variceal banding were included. Patients having cirrhosis due to other causes were excluded. Data was collected using a proforma that was filled by taking history, laboratory studies, abdominal ultrasound and upper gastrointestinal endoscopy. Gastric varices were classified using Sarin classification. SPSS 20 was used for statistical analysis. RESULTS: Out of 205 patients undergoing esophago-gastroduodenoscopy, 122(59.5%) were male and 83(40.5%) were female with an overall mean age of 49.5±7.49 years. Gastric varices were present in 30(14.6%) patients. Among them, type 1 was present in 23(76.71%), type 2 in 6(19.86%) and isolated gastric varices type 1 in 3(10.27%).Isolated gastric varices type 2 was not present in any patient. CONCLUSIONS: Gastric varices were present in minority of patients undergoing esophago-gastroduodenoscopy, and among them, gastroesophageal varices type 1 was the most common, while isolated gastric varices type 2 was not present in any patient.

Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome.

BACKGROUND: Hepatopulmonary syndrome (HPS) is a complication of advanced liver disease. The impact of HPS on survival is not clearly understood. MATERIAL AND METHODS: A prospective study was carried out at Department of Medicine, King Edward Medical University Lahore from June 2011 to May 2012. Patients with cirrhosis of liver were evaluated for presence of HPS with arterial blood gas analysis and saline bubble echocardiography. All patients were followed for 6 months for complications and mortality. Cox regression analysis was done to evaluate role of HPS on patient survival. RESULTS: 110 patients were included in the study. Twenty-nine patients (26%) had HPS. MELD score was significantly higher (p < 0.01) in patients with HPS (18.93 ± 3.51) as compared to that in patients without HPS (13.52 ± 3.3). Twenty two (75.9%) patients of Child class C, 5 (17.2%) patients of Child class B and 2 (6.9%) patients of Child class A had HPS (P 0.03). The clinical variables associated with presence of HPS were spider nevi, digital clubbing, dyspnea, and platypnea. HPS significantly increased mortality during six month follow up period (HR: 2.47, 95% CI: 1.10- 5.55). Child-Pugh and MELD scores were also associated with increased mortality. HPS was no longer associated with mortality when adjustment was done for age, gender, Child-Pugh, and MELD scores (HR: 0.44, 95% CI: 0.14-1.41). Both the Child-Pugh and MELD scores remained significantly associated with mortality in the multivariate survival analysis. CONCLUSIONS: HPS indicates advanced liver disease. HPS does not affect mortality when adjusted for severity of cirrhosis.