OBJECTIVES: To determine the clinical and laboratory parameters that may predict the presence of esophageal varices in children and adolescents with portal hypertension. PATIENTS AND METHODS: Overall, 111 patients with portal hypertension and no previous history of digestive bleeding underwent esophagogastroduodenoscopy for detection of esophageal varices. A univariate analysis initially was carried out, followed by a logistic regression analysis to identify the independent variables associated with the presence of esophageal varices. Sensitivity and specificity rates, positive predictive value, negative predictive value, and the accuracy of the predictive variables identified among cirrhotic patients were calculated with the esophagogastroduodenoscopy as the reference test. RESULTS: Sixty percent of patients had esophageal varices on the first esophagogastroduodenoscopy. Patients with portal vein thrombosis and congenital hepatic fibrosis were 6.15-fold more likely to have esophageal varices than cirrhotic patients. When we analyzed 85 cirrhotic patients alone, splenomegaly and hypoalbuminemia remained significant indicators of esophageal varices. Only spleen enlargement showed appropriate sensitivity and negative predictive value (97.7% and 91.7%, respectively) to be used as a screening test for esophageal varices among cirrhotic patients. CONCLUSIONS: In reference services and research protocols, endoscopic screening should be performed in all patients with portal vein thrombosis and congenital hepatic fibrosis. Among cirrhotic patients, the indication should be conditioned to clinical evidence of splenomegaly or hypoalbuminemia. For clinicians, the recommendation is to emphasize the orientations given to guardians of patients with portal vein thrombosis and congenital hepatic fibrosis as to the risk of digestive bleeding. Cirrhotic patients with hypoalbuminemia and splenomegaly should receive the same orientations.
OBJECTIVES: To determine the clinical and laboratory parameters that may predict the presence of esophageal varices in children and adolescents with portal hypertension. PATIENTS AND METHODS: Overall, 111 patients with portal hypertension and no previous history of digestive bleeding underwent esophagogastroduodenoscopy for detection of esophageal varices. A univariate analysis initially was carried out, followed by a logistic regression analysis to identify the independent variables associated with the presence of esophageal varices. Sensitivity and specificity rates, positive predictive value, negative predictive value, and the accuracy of the predictive variables identified among cirrhoticpatients were calculated with the esophagogastroduodenoscopy as the reference test. RESULTS: Sixty percent of patients had esophageal varices on the first esophagogastroduodenoscopy. Patients with portal vein thrombosis and congenital hepatic fibrosis were 6.15-fold more likely to have esophageal varices than cirrhoticpatients. When we analyzed 85 cirrhoticpatients alone, splenomegaly and hypoalbuminemia remained significant indicators of esophageal varices. Only spleen enlargement showed appropriate sensitivity and negative predictive value (97.7% and 91.7%, respectively) to be used as a screening test for esophageal varices among cirrhoticpatients. CONCLUSIONS: In reference services and research protocols, endoscopic screening should be performed in all patients with portal vein thrombosis and congenital hepatic fibrosis. Among cirrhoticpatients, the indication should be conditioned to clinical evidence of splenomegaly or hypoalbuminemia. For clinicians, the recommendation is to emphasize the orientations given to guardians of patients with portal vein thrombosis and congenital hepatic fibrosis as to the risk of digestive bleeding. Cirrhoticpatients with hypoalbuminemia and splenomegaly should receive the same orientations.
Authors: Agostino Colli; Juan Cristóbal Gana; Jason Yap; Thomasin Adams-Webber; Natalie Rashkovan; Simon C Ling; Giovanni Casazza Journal: Cochrane Database Syst Rev Date: 2017-04-26
Authors: Simon C Ling; Thomas Walters; Patrick J McKiernan; Kathleen B Schwarz; Guadalupe Garcia-Tsao; Benjamin L Shneider Journal: J Pediatr Gastroenterol Nutr Date: 2011-03 Impact factor: 2.839
Authors: Benjamin L Shneider; Bob Abel; Barbara Haber; Saul J Karpen; John C Magee; Rene Romero; Kathleen Schwarz; Lee M Bass; Nanda Kerkar; Alexander G Miethke; Philip Rosenthal; Yumirle Turmelle; Patricia R Robuck; Ronald J Sokol Journal: J Pediatr Gastroenterol Nutr Date: 2012-11 Impact factor: 2.839