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Abstract
Hepatitis C virus (HCV) is considered the most common etiology of chronic liver disease (CLD) in Egypt. (Strickland et al., 2002). An Important cause for the high exposure to HCV was the establishment of a large reservoir of infection as a result of extensive schistosomiasis control programs (Frank et al., 2000). The concomitant infection or overinfection with HCV in patients with bilharziasis could be the cause of aggravation of liver damage (Shapiro et al., 1998).
Esophageal and gastric varices are common manifestations of advanced chronic liver disease, but other endoscopic gastrointestinal manifestations of portal hypertension may occur. In the upper gastrointestinal tract, portal hypertensive gastropathy, particularly when severe, and gastric antral vascular ectasias are important alternative causes of gastrointestinal bleeding. Portal hypertensive enteropathy is an uncommon source of gastrointestinal bleeding, and its overall clinical significance remains unknown (Cheung et al., 2001).
Endoscopy can assess the presence and size of gastroesophageal varices, the appearance of the variceal wall, and the presence and severity of portal hypertensive gastropathy (Escorsell et al., 2001). It has greatly facilitated the management of some patients with chronic liver disease. Upper endoscopy plays a pivotal role in the diagnosis and management of oesophageal and gastric varices (Lau et al., 1997). It is used for the prophylaxis of the first bleeding episode, therapy of active bleeding and prophylaxis of recurrent bleeding (Biecker et al., 2005).
The aim of this work is to screen the endoscopic upper GIT lesions in patients with endemic chronic liver disease and to correlate between the grade of chronic liver disease (Child’s grading) and the upper endoscopic findings were assessed.
The current cross-sectional study was conducted on one hundred cases who were diagnosed as having chronic endemic liver disease (mixed schistosomal & HCV infection) by history, clinical examination, laboratory investigations and ultrasound examination. Upper gastro-intestinal endoscopy was done for all cases examining their oesophagus, stomach and duodenum using video-endoscope system. All endoscopic findings were reported in details including their nature, topography and grade using the most recent relevant classifications.
Regarding the prevalence of OV and its correlation with Child’s classification, we found that only 28.1% of Child A patients had oesophageal varices, 89.3% of Child B patients had oesophageal varices, while all patients (100%) of Child C had oesophageal varices, it means that the frequency of varices in our patients increases with their Child score.
Also, we found that grade I oesophageal varices was more common among Child B group, while grade II, III & IV oesophageal varices were more common among Child C group with statistically high significant difference in between. This finding points to the significant correlation between variceal size & severity of liver disease (Child’s classification).
Regarding gastric extensions & gastric varices we found that Child’s C class had the highest prevalence of both.
Regarding PHG, we found that mild PHG was more common among Child A group while severe PHG was more common among Child C group with statistically highly significant difference in between reflecting a significant correlation between the severity of liver disease (Child’s classification) & the severity of PHG.
Regarding gastric erosions we found that the severer the liver disease, the higher the prevalence of gastric erosions, however these differences were statistically insignificant.
Regarding the prevalence of GAVE, we found that only 3% of patients had evidence of GAVE and all of them were Child C. The few number of this finding was unsuitable for doing relevant statistical analysis.
Regarding duodenopathy, we found that Child C group had higher prevalence of dudenopathy in comparison to other subgroups with statistically significant difference in between.
Regarding prevalence of duodenal erosions, 14% had duodenal erosions, of them, 3% are Child A, 2% are Child B and 9% are Child C with no statistically significant difference in between.
Regarding the prevalence of Duodenal Ulcers, 16% had evidence of Duodenal Ulcer, of them, 4% were Child A, 8% were Child B and 4% were Child C with statistically highly significant difference in between.
Regarding GERD, we found that the prevalence of GERD was relatively low (7.5%) among Child C patients in comparison to other group, also, GERD-A was more common among Child A patients, GERD-B was only found in Child C patients and GERD-C was only found in Child B patients with statistically highly significant difference in between which reflects no correlation between GERD & Child’s classification.
Regarding other upper GIT endoscopic findings, such as, oesophageal moniliasis, gastric ulcers and gastric polyps, they were detected at low frequencies (3%, 4% and 4% respectively) among our patients without any significant correlation between them & Child’s classification.