Background: Recent guidelines from an AASLD Single Topic Symposium suggest that patients with cirrhosis, including those with primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC), should be screened for oesophageal varices when the platelet count is ,140 000/mm 3 . Aim: To determine the validity of these guidelines in clinical practice in patients with PBC or PSC. Methods: Retrospective review of individuals undergoing screening upper endoscopy for oesophageal varices at a single centre. Oesophageal varices were reported as being present or absent. Results: A total of 235 patients with chronic liver disease, including 86 patients with PBC (n = 79) or PSC (n = 7), 104 patients with chronic viral hepatitis, and 45 with non-alcoholic cirrhosis of differing aetiologies, underwent a single screening endoscopy between 1996 and 2001. Oesophageal varices were detected in 26 (30%) of the PBC/PSC group, 38 (37%) of the viral hepatitis group, and 21 (47%) of the ''other'' group. Applying multiple logistic regression analysis to the data in the group with PBC/PSC, platelets ,200 000/mm 3 (odds ratio (OR) 5.85 (95% confidence interval (CI) 1.79-19.23)), albumin ,40 g/l (OR 6.02 (95% CI 1.78-20.41)), and serum bilirubin .20 mmol/l (OR 3.66 (95% CI 1.07-12.47)) were shown to be independent risk factors for oesophageal varices. Prothrombin time was unhelpful. The values at these cut offs were not useful in predicting oesophageal varices in the other groups. Conclusion: We conclude that current guidelines recommended by the AASLD Single Topic symposium are invalid in our cohort of patients with PBC and PSC. Patients with a platelet count ,200 000/mm 3 , an albumin level ,40 g/l, and a bilirubin level .20 mmol/l should be screened for oesophageal varices.

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Brain MRI showed a high frequency (64%) of T1 hyperintensity in the basal ganglia of patients with portal hypertension, which correlated positively with blood manganese levels. This abnormality was found in 100% of the patients with portal hypertension and in 43% of those with mild cirrhotic disease.

Objective: To determine plasma zinc concentrations in children and adolescents with cirrhosis and to investigate the association between these results and dietary zinc intake, anthropometric data, and severity of liver disease.Methods: Plasma zinc concentration was assessed by atomic absorption spectrophotometry in 30 children and adolescents with cirrhosis (105.0±60.0 months; 22 girls) and 27 without liver disease (122.3±47.3 months, 14 girls). Dietary zinc data were evaluated by 3-day food intake records. Anthropometry measures included height, weight, skinfold thickness, brachial circumference, and upper arm muscle size. Severity of liver disease was classified according to the Child-Pugh, MELD, and PELD criteria. Results:The mean (± standard deviation) plasma zinc concentrations in control subjects and patients were 105.69±19.46 and 75.44±24.45 µg/dL, respectively (p < 0.001). No associations were found between anthropometric measures, dietary zinc intake, and plasma zinc concentration. There was statistical difference related to plasma zinc concentrations between Child-Pugh B + C patients and control subjects (p < 0.001), and concerning PELD, between patients below the cutoff score of 15 and those above (p = 0.002). Conclusions:The prevalence of hypozincemia was 43% for patients with cirrhosis. Although low plasma zinc concentration was associated with more severe liver disease, it was present even in some Child-Pugh A patients. Therefore, zinc supplementation should be considered for cirrhotic children.J Pediatr (Rio J). 2009;85(4):359-364: Zinc, liver cirrhosis, anthropometry, child. ResumoObjetivo: Determinar a concentração plasmática de zinco em crianças e adolescentes cirróticos e investigar a associação entre esses resultados e a ingestão dietética de zinco, os dados antropométricos e a gravidade da doença hepática.Métodos: As concentrações plasmáticas de zinco foram avaliadas por espectrofotometria de absorção atômica em 30 crianças e adolescentes com cirrose (105,0±60,0 meses; 22 meninas) e 27 hígidas e sem doença hepática (122,3±47,3 meses, 14 meninas). Os dados relacionados ao zinco dietético foram avaliados por registro de ingestão alimentar de 3 dias. A antropometria incluiu peso, altura, espessura da dobra cutânea, circunferência braquial e área muscular do braço. A gravidade da doença hepática foi classificada de acordo com os critérios de Child-Pugh, MELD e PELD. Resultados: As concentrações plasmáticas de zinco dos indivíduos controles e dos pacientes foram 105,69±19,46 e 75,44±24,45 µg/dL, respectivamente (p < 0,001). Nenhuma associação foi encontrada entre os índices antropométricos, a ingestão dietética e o zinco plasmático. Houve diferença estatística nas concentrações de zinco plasmático entre pacientes Child-Pugh B+C e controles (p < 0,001), e com relação ao PELD, entre pacientes abaixo e acima do ponto de corte 15 (p = 0,002). Conclusão:A prevalência de hipozincemia foi de 43% para pacientes com cirrose. A baixa concentração plasmática de zinco foi associada com a doença hepát...