الفهرس 
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Abstract
Portal hypertension is one of the most important complication of liver cirrhosis, leading to the development of oesophageal varices (OV). Variceal bleeding carries high morbidity and mortality. The prevalence of varices among cirrhotic patients is variable, ranging from 24% to 80%, therefore, endoscopic screening of all patients with liver cirrhosis would result in a large number of unnecessary additional burdens to endoscopic units. Several studies have examined how to identify patients with varices using non-invasive or minimally invasive methods to avoid endoscopy in patients with low risk of varices. The present study was designed to evaluate serum serotonin level and its possible association with varices in patients with liver cirrhosis. It included 80 persons attended to Tropical medicine department endoscopy unit, Tanta University Hospital, and fulfilling the inclusion criteria. All cases were submitted to full history taking, thorough clinical examination, laboratory investigations, ultrasound examination and upper GI endoscopy. Cases were divided into three groups: group A: 30 patients with cirrhosis with esophageal varices. group B: 30 patients with cirrhosis and without esophageal varices. group C: 20 healthy persons as a control group. Finally, serum serotonin level was determined serologically and correlated with other variables. On statistical analysis of data obtained from studied cases the following results were found:- In the present study, 60 cases with liver cirrhosis were included; the mean age was 55.47±5.84 in patients with varices compared to 54.10±5.57 in patients without varices.There was no statistically significant difference between group (A and B) as regards the age and gender. There was a statistically significant difference in jaundice, ascites, splenomegaly, and lower limb edema which were prominent in group A (cirrhotic with varices) . There was statistically significant relation between low haemoglobin, and low platelets count and presence of varices. There was no statistical significance between groups as regards alanine transaminase (ALT), aspartate transaminase (AST). There was positive relation between low albumin level and varices presence which was statistically significant. There was positive relation between bilirubin level and varices presence which was statistically significant. As regards coagulation profile there was positive relation between INR level with varices presence which was statistically significant. There was no statistically significant difference between the studied groups as regards the frequencies of HCV and HBV infections. However HCV infection was the most common cause of liver cirrhosis in the studied patients. Most cases with varices were Child class B and C, and most cases without varices were child class A. Also, cases of varices have higher Child score compared with cases without varices. MELD, APRI, FIB-4 scores were higher in patients with varices than patients without varices. PC/SD was lower in patients with varices than patients without varices. As regards ultrasonographic findings, the portal vein diameter, spleen size and ascites were statistically significantly higher in patients with varices compared with patients with no varices. Serum serotonin level was significantly higher in patients with varices (mean = 86.13 + 11.38 ng/mL) than patients without varices (mean = 59.51 + 8.09 ng/mL) and control group (mean = 27.04 + 7.52 ng/mL) (P value<0.001). The following results were determined: Serum serotonin A cutoff value of 71.18 above which patient was predicted to have OV (AUROC= 0.987) with sensitivity 96.67 %, specificity 93.33%, PPV 93.5 %, NPV 96.6%. Platelet count/spleen diameter ratio A cutoff value of <1113.3 could significantly predict OV (AUROC= 0.904) with sensitivity 89.29 %, specificity 79.67 %., PPV 78.1%, NPV 88.5 %. MELD score A cutoff value of >8 could significantly predict OV (AUROC= 0.899) with sensitivity 83.33 %, specificity 80.00 %., PPV 80.6%, NPV 82.8 %. APRI score A cutoff value of >0.4 could significantly predict OV (AUROC= 0.731) with sensitivity 70 %, specificity 60 %., PPV 63.6%, NPV 66.7 %. FIB-4 score A cutoff value of >2.09 could significantly predict OV (AUROC= 0.752) with sensitivity 63.33 %, specificity 83.33 %., PPV 79.2%, NPV 69.4 %. On comparing these together results the following was concluded The sensitivity: Serum serotonin came with the highest sensitivity 96.67%, followed by platelet count / spleen diameter (PC/SD) ratio with sensitivity (89.29%), followed thirdly by MELD score (83.33%), followed by APRI score (70%), and lastly FIB-4 (63.33%). The specificity: Serum serotonin had the highest specificity (93.33%), followed by FIB-4 (83.33%), followed by MELD with value (80 % ) , followed by PC/SD (76.67%) . APRI score had the lowest value (60%) Positive predictive value (PPV): The highest PPV was that of serum serotonin (93.5) followed by MELD (80.6), FIB-4 and PC/SD came next with values (79.2 , 78.1) respectively , lastly came the APRI score with the least value (63.6) . Negative predictive value (NPV): Serum serotonin was the best negative predictor followed by PC/SD, then came MELD followed by FIB-4 and APRI score. Area under the curve Highest value is that of the serum serotonin followed by PC/SD then came MELD score, then came with close results FIB-4 and APRI scores.