Oesophageal varices in patients with liver cirrhosis attending a major tertiary hospital in Ghana

Abstract

Introduction Oesophageal variceal bleeding is a potentially fatal consequence of portal hypertension in cirrhotic patients. In Ghana, bleeding oesophageal varices (OV) are a significant cause of acute upper gastrointestinal bleeding with comparatively high mortality. This study was to determine the prevalence of OV and its clinical correlate in cirrhotic patients. Methods This was a cross sectional hospital based study of 149 subjects with liver cirrhosis from 5 th November, 2015 to 4 th November, 2016. Demographic and other clinical data were collected using standardized questionnaire. Liver function, full blood count, HBsAg and anti-HCV Ab tests were done for all patients. All patients underwent an abdominal ultrasound to assess liver and document ascites. Upper GI endoscopy (UGIE) was done to screen for and grade varices. Results A total of 149 patients with a mean age of 45 ± 12.28 years were evaluated. There were 77.85% and 22.15% men and women respectively, with a male to female ratio of 3.5:1. By Child-Pugh Classification, 12 (8.16%) patients were in class A, 64 (43.54%) in class B and 71 (48.3%) in class C at presentation. On UGIE, 135 (90.60%) had varices and 14 patients (9.40%) had no varices. One hundred and eleven of the varices (82.22%) were large varices and the rest (17.78%) small varices. Conclusion Majority of cirrhotic patients present late with advance disease to this referral centre. Most have large varices on their first screening endoscopy. Prophylactic treatment should be considered for all cirrhotics especially patients with decompensated liver cirrhosis when UGIE cannot be done immediately.

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index

“…The median age at diagnosis for cirrhotic patients was 46 years, similar to the findings of a singlecenter study conducted at the Korle Bu Teaching Hospital in Accra, Ghana, in which the mean age of patients was 45 years (11). This figure has not changed significantly in almost 15 years, confirming that cirrhosis affects individuals during their most productive years of life (15).…”

“…Additional studies validating the APRI score and The sero-prevalences of antibodies to HCV were 3.7% among persons with cirrhosis and 6.4% among those with HCC. Other studies have reported estimates between 2.7-8.7% for cirrhosis and 6% for HCC (9,11,25). Although the prevalence of HCV-related liver disease is lower than in other countries such as Egypt and the United States, HCV treatment is not readily available in Ghana, and access to treatment is further hindered by the need for expensive tests, including HCV viral load and genotyping.…”

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index.

“…The median age at diagnosis for cirrhotic patients was 46 years, similar to the ndings of a single-center study conducted at the Korle Bu Teaching Hospital in Accra, Ghana, in which the mean age of patients was 45 years (11). This gure has not changed signi cantly in almost 15 years, con rming that cirrhosis affects individuals during their most productive years of life (15).…”

“…Furthermore, in Ghana, there are few studies on the characteristics and clinical pro le of patients presenting with ESLD. It is thought that similar to liver cancer, most patients with cirrhosis in Ghana present late (11), however there is little in the published literature to describe the stage and severity at presentation, nor the common causes of ESLD in Ghana. Additionally, little is known about the performance of non-invasive markers for diagnosis of ESLD in this region.…”

Causes of Upper GI Bleed: Variceal or non-variceal.

“…Duah A, et al reported that male to female ratio was 3.5:1 in his study on CLD patients with Child-Pugh Classification 8.16% in class A, 43.54% in B, 48.3% class C and after endoscopy 90.60% had esophageal varices with 9.40% no varices: 82.22% large varices 17.8% had small varices. 23 Hossain E, et al 22 reported that upper GI endoscopy was done in all the UGIB patients and 45% patients were having medium sized, 27% had small sized and 19% had large sized varices.…”