Evaluation of esophageal varices with non invasive methods in liver cirrhosis

Liver cirrhosis is a fatal disease with hepatocellular insufficiency and portal hypertension symptoms. Esophageal varices are a serious consequence of portal hypertension in patients with liver cirrhosis. Endoscopy is the most commonly used method for the evaluation of esophageal varices. The aim of this study is to evaluate non invasive predictors of presence and size of esophageal varices in chronic hepatitis B or C positive liver cirrhosis patients. Three hundred and twenty four cirrhotic patients with hepatitis B or C who applied to Gastroenterology clinic of Gaziantep University between the years of 2009-2015 were included in the study. Demographic, clinical, laboratory, radiological (spleen size, portal vein diameter, portal flow), and endoscopic (presence and size of esophageal varices) findings were obtained from the patients files as retrospectively. Platelet count/spleen size ratio was obtained from platelet count by dividing the spleen size in millimeters. The relationship between presence of varices and laboratory/radiological findings were assessed. A total of 324 patients were included. The mean age was 57.4±11.2 years; 178 (54.9%) were men, and 146 (45.1%) women. 164 patients were chronic hepatitis B related cirrhosis and 160 were chronic hepatitis C related cirrhosis. Esophageal varices were present in 255 (78,7%) patients and in 69 patients (21.3%) had no esophageal varices. Out of 255 patients, 97 (29.9%) had grade 1, 129 (%39.8) grade 2, 29 (%9) grade 3 varices. Child-Pugh classification, 170 (52.5%) patients were classified as class A, 94 (29%) as class B, and 60 (18,5%) as class C. Spleen size, portal vein diameters, platelet count and Platelet count/spleen size ratio were statistically significant difference in varices group according to non-varices group (p=0001). In the estimation of varices; cut off value of platelet count/spleen size ratio were found ≤846 with sensitivity 90 %, specificity 91 %, positive and negative predictive values of 97,4% and 71,5%, respectively. For estimate presence of esophageal varices in patients with cirrhosis, platelet count/spleen size ratio was found with high sensitivity and specificity. The ratio ≤846 is important for estimating presence of varices. This ratio as non invasive method can be useful for estimating presence of varices in liver cirrhosis patients.