الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. It is estimated that approximately 170 million individuals, i.e. 3% of the world population, are chronically infected with HCV. The highest HCV prevalence in the world occurs in Egypt, where it is 14.7%. Among patients exposed to HCV, 15% to 20% will clear the infection within 6 months. The remaining 80% to 85% of patients who still have detectable HCV RNA for 6 months are considered to be chronically infected. Unfortunately, up to 20% of individuals with chronic hepatitis C eventually develop liver cirrhosis, which may be complicated by hepatocellular carcinoma (HCC), hepatic decompensation. Hepatic decompensation can occur in several forms. Most common is ascites, followed by variceal bleeding, encephalopathy and jaundice. The risk for decompensation is estimated to be close to 5% per year in cirrhotics. Portal hypertension is the main complication of chronic hepatitis C, most frequently in cirrhosis, leading to the development of portosystemic collaterals of which the most clinically significant are those that form gastroesophageal varices. Variceal hemorrhage is the most serious complication of portal hypertension and is associated with a high mortality rate. At the time of diagnosis of cirrhosis, varices are present in about 60% of decompensated and 30% of compensated patients. Portal hypertensive gastropathy (PHG) has a prevalence of 80% in cirrhotic patients, with chronic bleeding in 11% and acute bleeding in 2•5%. Hepatic stellate cell (HSC) has the major role in hepatic fibrogenesis in HCV cirrhotic patients, which leads to architectural and hemodynamic changes of liver parenchyma and portal circulation respectively, liver stiffness increases due to these architectural and hemodynamic changes.
Although liver biopsy clearly provides important diagnostic and prognostic information and helps define treatment plans, it must be recognized that it may be associated with drawbacks that have prompted questions about its value. The current consensus is that every cirrhotic patient should be endoscopically screened for varices at the time of diagnosis. The aim of the screening for esophageal varices is to detect patients requiring prophylactic treatment. Serum biomarkers have been proposed as an inexpensive and effective alternative to replace liver biopsy and can be subdividing into three categories: Indirect markers, direct markers, or combination of indirect and direct markers. Ultrasonography (US)/color Doppler-US (CDUS) is the preferred initial examination in patients with suspected portal hypertension. US can detect signs of portal hypertension such as splenomegaly, presence of portocollateral vessels, and ascites, and complement this information with data on liver size, echotexture, and margins, which can suggest underlying cirrhosis. The congest