الفهرس 
• Portal hypertensionOnly 14 pages are availabe for public view
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Abstract
L
iver cell failure is one of the most dangerous diseases. In Egypt portal hypertension is the most devastating complication of chronic liver diseases and is the most common cause of mortality and morbidity in patients with liver cirrhosis. Haematemesis is the most important complication of portal hypertension threatening the patient’s life. Oesophageal varices are considered the first cause of haematemesis in patients with portal hypertension in Egypt. Endoscopic variceal ligation (EVL) is increasingly becoming the most suitable method for eradication of oesophageal varices aiming to decrease the incidence of recurrent variceal bleeding. In spite of this, it has minimal post banding complications compared to other methods. One of these complications is post banding ulcer formation and hence post banding bleeding.
It is unclear whether the presence of post-band ulceration require specific therapy to accelerate the healing process or not. Treatment of post-band ulcers has been mostly empirical with drugs used for peptic ulcer diseases, very few data exists regarding adjuvant therapy for EVL.
This study was designed to evaluate the effect of sucralfate on post banding complications and ulcer formation, and to clarify it’s role in healing of post-banding oesophageal ulcers. It was conducted in the Endoscopy unit, Department of Hepatology, Gastroenterology (Naser Institute), Emergency Haematemesis Unit and Central Gastrointestinal Endoscopy Unit, (Ain Shams University Hospitals) also, Endoscopy Department (Palestine Hospital).
For better assessment this study was designed to be randomized, double blinded, placebo controlled trial in order to role out any possible factors that may interrupt, strength, or weaken the clinical and or endoscopic judgment. The current trial included a group of sixty-two chronic liver disease patients(schistosomal and/or post viral) fulfilling the eligibility criteria and all patients underwent oesophageal variceal band ligation.
Every patient in this study had took I.D number ,odd number took sucralfate and even number took placebo, by this randomization the recruited patients were allocated into two groups:
Study group: Included 31 patients in whom endoscopic band ligation was done then received sucralfate 1 gm every 6 hours for 2 weeks
Control group: Included 31 patients in whom endoscopic band ligation was done then received placebo every 6 hours for 2 weeks.
Both groups were subjected to thorough history taking, clinical examination, laboratory investigations, abdominal ultrasonography and upper GI endoscopy and were followed up after one week by a questionnaire about symptoms of complications (chest pain, dysphagia and rebleeding) and two weeks also by the same questionnaire in addition to upper endoscopy to evaluate ulcers(depth, number and size).
At one & two weeks evaluation, complications were minor and transient (pos-band chest pain & dysphagia) without significant difference between the study and control groups (P>0.05). Major complications like bleeding and mortality were not encountered throughout the study.
There was benificial effect of band ligation on decreasing the size and grading of oesophageal varices in both groups but without significant difference(P>0.05).
The rate of occurance of post-banding ulcers was significantly higher in the control group (74.2%) compared to the study group (38.7%) (P<0.05). However, the ulcers in both groups were superficial.
There was a significant difference between both groups regarding the size of post-banding ulcers, as the mean size of ulcers was larger in control group (3.8mm ± 1.7 ) versus (2.7 mm ± 1.2 ) in the study group, P value <0.05.
As regard to grading of OV and the development of ulcers, there was no statistically significant relation between pre-banding grade of OV and development of ulcers in both groups(P>0.05).
There was no significant relation between smoking and development of ulcers in both groups. Also there was no significant relation between hepatic reserve in form of Child pough Classification and development of ulcers in both groups(P>0.05).