Managing liver cirrhotic complications: Overview of esophageal and gastric varices

Abstract

Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

External validation of CAGE‐B and SAGE‐B scores for Asian chronic hepatitis B patients with well‐controlled viremia by antivirals

“…LS was measured using TE (FibroScan ® , EchoSens, Paris, France) in a standard manner 21,24 . Cirrhosis on ultrasonography was defined when at least one of the following criteria was fulfilled; irregular‐nodular liver surface, highly coarse liver echo‐texture, blunt liver edge, shrunken liver parenchyme, disturbed or destroyed vascular architecture, and other findings suggestive of portal hypertension such as splenomegaly (>12 cm) or porto‐systemic collaterals 25–30 …”

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

“…Collateral circulation occurs when the HVPG ≥ 10 mmHg, termed clinically significant portal hypertension (CSPH), and the most common consequence of collateral circulation is esophageal varices (EV). Variceal bleeding can occur when the HVPG ≥ 12mmHg 3 , 4 , which is potentially life-threatening, and the 6-week mortality is as high as nearly 18% 5 . Therefore, the early diagnosis of varices needing treatment (VNT) is crucial.…”

Mac-2 Binding Protein Glycosylation Isomer for Screening High-Risk Esophageal Varices in Liver Cirrhotic Patient

“…The mortality rate for cirrhosis is higher in low-income regions such as sub-Saharan Africa, Central Asia, and Southeast Asia [2]. Portal hypertension is a complication of cirrhosis and esophageal variceal bleeding occurs at a portal pressure of >12 mmHg [3]. Variceal bleeding is a dreaded complication of cirrhosis and has a 6-week mortality rate of 26% after an acute episode [4].…”