Prevalence and Predictors of Esophageal Varices in Patients With Primary Biliary Cirrhosis

Levy, Cynthia; Zein, Claudia O.; Gomez, Justin M.; Soldevila-Pico, Consuelo; Firpi, Roberto J.; Morelli, Giuseppe; Nelson, David R.

doi:10.1016/j.cgh.2007.02.031

Cited by 49 publications

(36 citation statements)

References 34 publications

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“…In PSC, a platelet count less than 150,000/mm 3 identifies patients most likely to benefit from endoscopic screening [75]. In PBC, a Mayo risk score ≥ 4.1 [76] and platelet count cutoffs less than 140,000/mm 3 [77] and less than 200,000/mm 3 [78] have been proposed to identify patients most likely to have esophageal varices.…”

Section: Management Of Complications Of Advanced Liver Diseasementioning

confidence: 98%

Latest and Emerging Therapies for Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Zein

Lindor

2010

Curr Gastroenterol Rep

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Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are the two most common causes of chronic cholestatic liver disease in adults. In PBC, therapy with ursodeoxycholic acid (UDCA) is safe and has been associated with tangible biochemical, histologic, and survival benefits. However, a need for different or adjuvant therapies remains for specific subsets of PBC patients, including those who do not respond to UDCA and those who have advanced histologic disease at presentation. Similarly, beneficial therapies for disease-related symptoms that do not typically respond to UDCA (eg, fatigue and pruritus) are still needed. In contrast to PBC, no medical therapy of proven benefit has been identified for patients with PSC. In PBC and PSC, adequate management of complications of chronic cholestasis is important. For both diseases, liver transplantation is the only curative option.

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Section: Management Of Complications Of Advanced Liver Diseasementioning

confidence: 98%

Latest and Emerging Therapies for Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Zein

Lindor

2010

Curr Gastroenterol Rep

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“…This goal was reasonably attained in the current study. Several studies have shown that ascites, 20 presence of spider nevi, 24 low prothrombin time, 18 alanine aminotransferase, and albumin levels, 24 high portal vein diameter, 18 splenomegaly, 14,17,20,22 and low platelet count [14][15][16][17][18][20][21][22][23] could serve as predictors of EV presence. However, all of these studies were quite heterogeneous, enrolling patients with cirrhosis of different causes (viral, alcoholic, and mixed) and different disease severity (Child B or endstage liver disease).…”

Section: Discussionmentioning

confidence: 99%

Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis†

et al. 2009

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P ortal hypertension (PH), defined by a hepatic venous pressure gradient (HVPG) greater than 6 mmHg, 1 is a common complication of cirrhosis. The presence and the development of esophageal varices (EV) is a clinical manifestation of PH, 2,3 with a prevalence that can range from 40% to 80% in patients with cirrhosis. This prevalence increases progressively in relation to the severity of liver damage. 4,5 The presence of EV is also a clear indicator of a certain stage of cirrhosis. 6 The development of EV in patients with cirrhosis occurs when the HVPG is greater than 10 mmHg, 3,7 with an incidence of approximately 5% per year and a yearly rate of progression to larger varices of 5% to 15%. 4,5,8 The clinical relevance of EV is linked to the risk of bleeding that occurs when HVPG is greater than 12 mmHg, 7-9 with a mortality rate that exceeds 20% within 6 weeks from the bleeding episode, despite aggressive treatment. 10 The Baveno IV 2005 Consensus Workshop 11 and the American Association for the Study of Liver Diseases 2007 single-topic symposium on portal hypertension 12 recommended that endoscopic screening for esophageal and gastric varices should always be performed when a diagnosis of cirrhosis is made. Upper endoscopy should be repeated at 2-year to 3-year intervals in patients without varices, and at 1-year to 2-year intervals in those with small varices, to evaluate their development or progression. 11,12 These guidelines might not be ideal for clinical

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“…However, in some countries both accessibility to endoscopy and resources may be limited [11][12][13], and these limitations together with the everincreasing workload on endoscopy units emphasises the need for simple and commonly available parameters that can non-invasively diagnose EV [14][15][16][17]. In many studies, thrombocytopenia was the factor most commonly associated with varices, though it lacked adequate accuracy, likely due to a multifactorial aetiology [18,19].…”

Section: Introductionmentioning

confidence: 95%

External Validation of the Platelet Count/Spleen Diameter Ratio for the Diagnosis of Esophageal Varices in Hepatitis C Virus-Related Cirrhosis

et al. 2008

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Prevalence and Predictors of Esophageal Varices in Patients With Primary Biliary Cirrhosis

Cited by 49 publications

References 34 publications

Latest and Emerging Therapies for Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Latest and Emerging Therapies for Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis

Insulin resistance is a risk factor for esophageal varices in hepatitis C virus cirrhosis†

External Validation of the Platelet Count/Spleen Diameter Ratio for the Diagnosis of Esophageal Varices in Hepatitis C Virus-Related Cirrhosis

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