The Risk Factors for Bleeding of Fundal Varices in Patients with Liver Cirrhosis.
- Author:
Eui Ju PARK
1
;
Jae Young JANG
;
Ji Eun LEE
;
Soung Won JEONG
;
Sae Hwan LEE
;
Sang Gyune KIM
;
Sang Woo CHA
;
Young Seok KIM
;
Young Deok CHO
;
Joo Young CHO
;
Hong Soo KIM
;
Boo Sung KIM
;
Yong Jae KIM
Author Information
1. Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Seoul, Korea. jyjang@schmc.ac.kr
- Publication Type:Original Article
- Keywords:
Cirrhosis;
Hypertension, portal;
Hepatic venous pressure gradient;
Fundal varices;
Portasystemic shunt, surgical
- MeSH:
Adult;
Aged;
Endoscopy, Gastrointestinal;
Esophageal and Gastric Varices/etiology/*physiopathology;
Esophagus;
Female;
Gastric Fundus;
Gastrointestinal Hemorrhage/etiology/*physiopathology;
Humans;
Hypertension, Portal/complications/*physiopathology;
Liver Cirrhosis/complications/*physiopathology;
Male;
Middle Aged;
*Portal Pressure;
*Renal Veins;
Risk Factors;
*Splenic Vein;
Stomach/*blood supply;
Vascular Fistula/complications/*physiopathology
- From:Gut and Liver
2013;7(6):704-711
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices. METHODS: In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied. RESULTS: There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1+/-7.7 mm Hg vs 19.7+/-5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3+/-5.8 mm Hg vs 17.0+/-8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016). CONCLUSIONS: Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.
