Clinical Assessment of Cases Presented with Esophageal Varices and Portal Hypertension in a Tertiary Healthcare Institute: An Observational Study

Abstract

Introduction: Portal hypertension (PHT) commonly accompanies cirrhosis of liver. Development of esophageal varices is one of the major complications of PHT. A major cause of PHT-related morbidity and mortality is the development of variceal hemorrhage, which occurs in 25-40% of patients. 1 Esophageal varices are diagnosed by endoscopy. Further follow-up should then relate to the initial size of varices. In case of large varices, endoscopic follow-up is not necessary and primary prophylaxis with a nonselective β-blocker should be started. Endoscopic band ligation is useful in preventing variceal bleeding in patients with medium or large varices. The present study was conducted to assess the clinical presentation of cases of portal hypertension presented with esophageal varices in tertiary healthcare institute. Material and methods:The present study was conducted at a tertiary healthcare teaching institute from July 2018 to October 2018 and 70 patients were studied. All the cases presented with PHT, which had been diagnosed clinically, biochemically, radiologically and endoscopically were included in the present study. Results: Incidence of esophageal varices in patients withPHT is approximately 90-95%, but only 30-50% develop variceal bleeding, which is usually associated mainly with fatal outcome. Pallor (88%), ascites (80%) and splenomegaly (70%) were common signs followed by icterus (52%). Asymptomatic esophageal varices were found in 80% of patients, 20% had Grade 1, 26% had Grade 2 and 34% had Grade 3 esophageal varices. Conclusions:Portal hypertension is largely a preventable condition because the commonest etiology is alcoholism. Asymptomatic esophageal varices, which is quite common, can be easily diagnosed with invasive endoscopy or otherwise suspected with noninvasive platelet/spleen size ratio in country like ours, where financial constraint is a main problem. It can be very useful and applicable at small centers like community health centers (CHCs) and primary health centers (PHCs) in our country with limited resources.