Study of the Relationship between Blood Ammonia Level and Esophageal Varices in Patients with Liver Cirrhosis

Ali, A.; Badawy, Amira M.; Sonbol, Ahmed; Ayad, Mohammed Elsayed

doi:10.21608/aeji.2015.17816

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…Measurement of blood ammonia revealed that it was significantly higher in patients with EV than in those without EV (p<0.001). Our finding is congruent with that of Ali et al (16), who also detected an increase in the mean values of blood ammonia in patients suffering from cirrhosis with varices in comparison to patients without varices.…”

Section: Discussionsupporting

confidence: 93%

Evaluation of the blood ammonia level as a non-invasive predictor for the presence of esophageal varices and the risk of bleeding

Elzeftawy

Mansour

Kobtan

et al. 2018

Turk J Gastroenterol

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Background/Aims: The development of esophageal varices (EV) and resultant bleeding are the most critical complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV. To find a non-invasive method for diagnosis of EV and to predict the bleeding risk is appealing and would decrease the cost and discomfort of upper endoscopy. The aim of our study was to evaluate the blood ammonia level as a predictor of the presence of EV and of a high risk of bleeding. Materials and Methods: In this cross-sectional study, a total of 359 patients with cirrhosis were examined for the presence of EV by upper endoscopy. Abdominal ultrasonography, calculation of the Child-Pugh score, and measurement of blood ammonia were performed for each patient. Results: The blood ammonia level was significantly higher in patients with EV than in those without it (p<0.001), and in patients with a high risk of variceal bleeding than in those with a low risk (p=0.026). Conclusion: An increased blood ammonia level and splenic vein diameter are predictors for the presence of EV and bleeding risk factors. The blood ammonia level may be clinically useful as it correlates with and is an independent predictor for both the endoscopic risk signs and risk factors of bleeding, and therefore, it could be used in patients with cirrhosis to decrease the number of screening endoscopies they are subjected to.

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Section: Discussionsupporting

confidence: 93%

Evaluation of the blood ammonia level as a non-invasive predictor for the presence of esophageal varices and the risk of bleeding

Elzeftawy

Mansour

Kobtan

et al. 2018

Turk J Gastroenterol

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“…Blood ammonia was significantly higher among patients with EV than controls ( P = 0.001). Other studies have found this relation between the presence of varices and elevated blood ammonia and even suggested a blood ammonia cutoff value for prediction of variceal presence [ 15 , 28 – 30 ]. This can be explained by the role ammonia plays in production of portal hypertension and hence development of varices [ 18 ].…”

Section: Discussionmentioning

confidence: 79%

Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy

El-Kalla

Mansour

Kobtan

et al. 2018

Gastroenterology Research and Practice

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Background Portal hypertensive gastropathy (PHG) is a common anomaly with potential for bleeding found in portal hypertension. Blood ammonia levels correlate well with liver disease severity and existence of portosystemic shunts. Increased ammonia results in vasodilation and hepatic stellate cell activation causing and exacerbating portal hypertension. Objective To assess the relation of blood ammonia to the presence and severity of portal hypertensive gastropathy in cirrhosis. Methods This cross-sectional study included 381 cirrhotics undergoing screening for esophageal varices (EV) divided into a portal hypertensive gastropathy group (203 patients with EV and PHG), esophageal varix group (41 patients with EV but no PHG), and control group (137 patients with no EV or PHG). A full clinical examination, routine laboratory tests, abdominal ultrasonography, child score calculation, and blood ammonia measurement were performed for all patients. Results Blood ammonia, portal vein, splenic vein, and splenic longitudinal diameters were significantly higher and platelet counts lower in patients with EV and EV with PHG than controls. Patients having EV with PHG had significantly higher bilirubin and ammonia than those with EV but no PHG. Severe PHG was associated with significantly higher ammonia, EV grades, and superior location and a lower splenic longitudinal diameter than mild PHG. The PHG score showed a positive correlation with blood ammonia and a negative correlation with splenic longitudinal diameter. Conclusions Blood ammonia levels correlate with the presence, severity, and score of portal hypertensive gastropathy in cirrhosis suggesting a causal relationship and encouraging trials of ammonia-lowering treatments for the management of severe PHG with a tendency to bleed.

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“…These results came in agreement with Sharma et al (2017) that found that there was no significant difference between esophageal and gastric varices regarding platelets. Also, agreed with the study conducted by Rezayat et al (2014) who evaluated changes of doppler indices in gastric varices patients with and without gastroesophageal varices.On the other hands, Ali et al (2015) found that there was a significant decrease in the mean values of platelet count/ spleen diameter ratio in cirrhotic patients with gastric varices in comparison to other patients without gastric varices. In the current study, splenic vein diameter, splenic vein cross sectional area, and splenic congestion index significantly increased among group Ca and group Cbthan group A and group B, and this came in concordance with the study of Esmat et al (2012) who found a statistically significant correlation between the presence and grade of gastroesophageal varices with the splenic diameter, and also was in concordance with results of Rezayat et al (2014) who found that in half of patients with portal hypertension the splenic vein diameter increases to more than 10 mm.…”

Section: Discussionmentioning

confidence: 88%

Assessment of Platelet Count and Doppler Ultrasound on Hepatic and Splenic Venoussystem as Non-Invasive Predictors of Gastric Varices in Patients With Liver Cirrhosis

Ghalwash

Soliman

Aboufarrag

et al. 2021

Al-Azhar Medical Journal

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Background: Gastric varices are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting.Objective: To assess platelet count and doppler ultrasound on hepatic and splenic venous system as noninvasive predictors of gastric varices in patients with liver cirrhosis with no history of previous endoscopic or surgical intervention for portal hypertension.

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Study of the Relationship between Blood Ammonia Level and Esophageal Varices in Patients with Liver Cirrhosis

Cited by 6 publications

References 10 publications

Evaluation of the blood ammonia level as a non-invasive predictor for the presence of esophageal varices and the risk of bleeding

Evaluation of the blood ammonia level as a non-invasive predictor for the presence of esophageal varices and the risk of bleeding

Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy

Assessment of Platelet Count and Doppler Ultrasound on Hepatic and Splenic Venoussystem as Non-Invasive Predictors of Gastric Varices in Patients With Liver Cirrhosis

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