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OESOPHAGEAL VARICES IN PATIENTS WITH LIVER CIRRHOSIS

A. O. Ajayi, E. A. Ajayi, T. H. Raimi, J. O. Fadare, O. A. Solomon, A. O. Adeoti

Abstract


About one third of cirrhotic patients with oesophageal varices (OV) develops an episode of oesophageal hemorrhage, and subsequently has high morbidity and mortality. Early detection and prevention of OV in these patients are crucial to minimizing complications. This study was carried out to determine the prevalence of OV among the cirrhotic patients at our institution. Fifty six patients with liver cirrhosis who had upper gastrointestinal endoscopy done were recruited into the study. The study was carried out at the Ekiti State University Teaching Hospital, Ado –Ekiti, between January 2010 and December 2011. Liver cirrhosis was diagnosed on the basis of liver biopsy, clinical and ultrasound findings. At the point of recruitment, a full medical history was taken. The severity of liver disease was assessed according to Child's classification. All the patients underwent upper gastrointestinal (GIT) endoscopy. The diagnosis of variceal bleeding was confirmed if an actively bleeding varix or a varix with adherent clot was seen. The following endoscopic features were recorded during the procedure: size, colour, and location of varices (oesophageal, fundal or portal gastropathy) and the presence of "red signs". Ethical approval for the study was obtained from hospital’s Ethics Committee and all the patients gave their individual signed consent. SPSS version 15.0 (SPSS, Inc., Chicago, Illinois, USA) was deployed for statistical analysis using the t-test for quantitative variables and χ2 test for qualitative variables. Differences were considered to be statistically significant if P value was less than 0.05. Fifty six cirrhotic patients comprising of 37 males and 19 females were recruited into the study. The Male: Female ratio was 1.9:1. The mean age for males was 51.6±10.2, while that of the females was 55.4±10.6. Oesophageal varices were found in 30 of the 56 patients giving an overall prevalence rate of 53.6%. All the varices were oesophageal in location; 73.3% (22/30) were males while 26.7% (8/30) were females. A large proportion (64.3%) of the patients were in Child’s grade A, while 28.5% were in Child’s Grade B and only 7.1% were in Child’s Grade C. Endoscopically, 13 of the varices were small (F1), 10 were medium sized (F2) while 7 were of large size (F3). The statistically significant risk factors for oesophageal varices found in this study were hepatitis B virus infection and tattoo marks. The prevalence of oesophageal varices in cirrhotic patients in this study was 53.6%. Upper gastrointestinal endoscopy is therefore recommended in the cirrhotic patients to ameliorate the risk of bleeding and the related high mortality.


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