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Abstract
C
hronic liver disease is a major health problem in Egypt, especially complicating schistosomiasis and viral hepatitis. Chronic HCV is the main cause of liver cirrhosis and liver cancer in Egypt, where it contains the highest prevalence of hepatatitis C in the world (18.9% or 7.2 million people).
Esophageal and gastric varices are common complications 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.
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. 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. It is used for the prophylaxis of the first bleeding episode, management of active bleeding and prophylaxis of recurrent bleeding.
The aim of this work was to screen the endoscopic upper GIT lesions in patients with chronic liver disease caused by either HCV alone or schistosomiasis alone, in a trial to evaluate the impact of each disease separately. This was done to determine if there is an association between these changes and the presence of portal hypertension and to clarify the correlation between these changes and the severity of liver disease.
The current cross-sectional study was conducted on one hundred cases who were diagnosed as having chronic endemic liver disease (Either schistosomal alone or HCV infection alone) 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 or accepted relevant classifications.
Regarding the prevalence of O.V. and its correlation with Child’s classification whatever the etiology, we found that 59% of Child A patients had oesophageal varices most of them with schistosomiasis, 95.8% of Child B patients had oesophageal varices most of them with chronic HCV, and (93.7%) of Child C had oesophageal varices with the majority of patients with schistosomiasis, it means that the frequency of varices in our patients increases with their Child score and it is more apparent in patients with schistosomiasis than those with HCV.
Also, we found that grade I oesophageal varices was more common among Child B group with the majority of patients belonging to schistosomiasis (G2), while grade II, III and IV oesophageal varices was more common among Child C group whatever the etiology of the underlying liver disease (whether schistosomiasis or HCV) with insignificant predominance in HCV patients (specially grade II and IV)., it means that there was higher grade of O.V. is associated with advanced grade of Child’s classification, with statistically high significant difference in between and it is more apparent in patients with schistosomiasis than those with HCV.
Regarding Gastric extensions and Gastric Varices we found that Child’s C class had the highest prevalence of both and as well schistosomal patients.
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) and the severity of PHG. Also there was higher prevalence of PHG in patients with chronic schistosomiasis than those with chronic HCV, which was more apparent in advanced liver disease (Child B and C)
Regarding gastric erosions we found that the frequency of it is not related to the severity of liver disease and schistosomiasis has no effect on the development of gastric erosions.
Regarding the prevalence of GAVE, we found that only 3% of patients had evidence of GAVE and all of them were Child C.
Regarding prevalence of duodenopathy, we found that it was of low frequency in our patients and not related to degree of liver disease.
Regarding the prevalence of duodenal ulcers in 100 patients, 8 patients (8%) had Duodenal Ulcers, of them, 5 patients were Child A (11.3%) (all of them chronic HCV), no patients were Child B and 3 patients were Child C (9.3%) , with statistically highly significant difference in between denoting no correlation between DU and portal hypertension.
Regarding prevalence of GERD in 100 studied patients, only (15%) had evidence of GERD.
Regarding correlation between GERD and Child-Pugh classification, it was found that prevalence of GERD was relatively low among Child C patients (0%) in comparison to other groups, GERD was more common among Child A patients (25%), while in child B it was (12.5%).
These findings indicate that there is no correlation between GERD and the severity of liver disease (Child’s classification).
Regarding other findings, such as, oesophageal moniliasis, gastric and ulcers and gastric and duodenal polyps we found that they were noticed at low frequencies and that they had no correlation between them and Child’s classification and as well the difference between the two groups of study was statistically insignificant regarding the prevalence of their findings.