Prognostic Value of Endoscopy in Children With Biliary Atresia at Risk for Early Development of Varices and Bleeding

Duché, Mathieu; Ducot, B.; Tournay, Elodie; Fabrè, Monique; Cohen, Jacob T.; Jacquemin, Emmanuel; Bernard, Olivier

doi:10.1053/j.gastro.2010.07.004

Cited by 110 publications

(120 citation statements)

References 35 publications

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…The reported prevalence of PHG varies greatly from 20% to 75% in patients with portal hypertension (Table 1) [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] , and varies greatly from about 35% to 80% in patients with cirrhosis (Table 2) [21, . For example, in a study of 373 cirrhotic patients, 299 (80.2%) had PHG [34] .…”

Section: Epidemiologymentioning

confidence: 99%

“…Itha et al [11] EHPVO in children 163 (12%) Not reported Not reported Rana et al [12] Portal hypertension 41 27 (66%) 19 (46%) 8 (20%) El-Rifai et al [13] Portal hypertension 24 14 (58%) 10 (42%) -moderate 4 (16%) Sogaard et al [14] Portal vein thrombosis 67 28 (42%) Not reported Not reported Figueiredo et al [15] Portal hypertension; cirrhosis 36 27 (75%) 5 (46%) Erden et al [16] Portal hypertension 57 15 (26.3%) Not reported Not reported Duché et al [17] Children, portal hypertension with biliary atresia 125 …”

Section: Not Reported Not Reportedmentioning

confidence: 99%

See 1 more Smart Citation

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

View full text Add to dashboard Cite

AIM:To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS:Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS:PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

show abstract

Section: Epidemiologymentioning

confidence: 99%

Section: Not Reported Not Reportedmentioning

confidence: 99%

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Gjeorgjievski¹

2016

WJH

View full text Add to dashboard Cite

show abstract

“…However, screening endoscopy is recommended for patients with conditions that have a high incidence of portal hypertension in an effort to identify variceal formation as early as possible. 22 Endoscopic findings of red markings or gastric varices are of concern for the presence or future development of UGIB. 3 Children who have been diagnosed with esophageal varices, red markings, or gastric varices on initial screening endoscopy should undergo endoscopic sclerotherapy or band ligation to prevent hemorrhage.…”

Section: Screening and Preventionmentioning

confidence: 99%

“…3 Children who have been diagnosed with esophageal varices, red markings, or gastric varices on initial screening endoscopy should undergo endoscopic sclerotherapy or band ligation to prevent hemorrhage. 22 In addition, the use of ␤-blockers in at-risk children is recommended as prophylaxis for variceal bleeding. 23 Children in a PICU should be considered for prophylaxis with histamine 2 receptor antagonists or proton pump inhibitors.…”

Section: Screening and Preventionmentioning

confidence: 99%

“…3 Indications for possible variceal bleeding include a history of autoimmune hepatitis, Budd-Chiari syndrome, cystic fibrosis, biliary atresia, portal vein thrombosis, or primary sclerosing cholangitis. 22 Family history should be assessed for inheritable diseases that may increase risk for UGIB, for example, liver disease, any history of requirements for clotting factor replacement, hemophilia A, hemophilia B, and Von Willebrand disease. 15 Defining the amount of bleeding and any associated symptoms is important.…”

Section: Historymentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Owensby

Taylor

Wilkins

2015

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. (J Am Board Fam Med 2015; 28:134 -145.)

show abstract

Banding ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children

Gana

Cifuentes

Cerda

et al. 2013

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Prognostic Value of Endoscopy in Children With Biliary Atresia at Risk for Early Development of Varices and Bleeding

Cited by 110 publications

References 35 publications

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Banding ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children

Contact Info

Product

Resources

About