Noninvasive markers for esophageal varices in children with cirrhosis

Abstract

Background The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. Purpose This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. Methods A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. Results Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. Conclusion Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of high-risk patients with EV and might reduce the need for invasive methods like EGD.

Small varices in chronic liver diseases

“…PC, therefore, can be a predictor of the presence of EVs [26,27]. However, PC was not independently associated with EVs in the study of Rahmani P et al [28 ▪ ]. AST/ alanine transaminase ratio (ALT) (AAR) and aspartate aminotransferase to platelet ratio index (APRI) showed sensitivity 82.4% and specificity of 36.4% with a cutoff value of 1.415, and sensitivity 83.2% and specificity 50% with a cutoff value of 1.3 for predicting EVs, respectively [29].…”

“…Studies show that spleen size can predict varices [27,29]. However, Rahmani P et al showed, though there were differences in spleen size between patients with and without EVs in univariate analysis, there was no difference in the logistic regression analysis [28 ▪ ]. Among patients with CLDs, splenomegaly occurs at a higher frequency in patients with EVs (100%) than in patients without EVs (70.6%) (P < 0.05) [25].…”

Use of biochemical parameters for non-invasive screening of oesophageal varices in comparison to elastography-based approach in patients with compensated advanced chronic liver disease

“…Therefore, the possibility to predict the presence of HRV by using a non-invasive test(s) would improve the management of patients with compensated advanced chronic liver disease (cACLD). Currently, a non-invasive blood test, that can predict the severity of portal pressure among patients with cACLD, is not established, although different biochemical tests in combination with other non-invasive tests could be useful in screening patients for the presence of HRV ( 6 , 7 ). Facing the current COVID-19 pandemics with further limited access to healthcare this approach becomes even more important.…”

Understanding the use of oral rehydration therapy: A narrative review from clinical practice to main recommendations

“…Volume loss is characterized by reduction in the volume of intracellular fluid and is mainly associated with loss of sodium and water. 2 , 3 , 4 …”