Abstract
Background/Goals: Esophageal varices (EV) in early histological stages of primary biliary cirrhosis (PBC) have been recognized but not well defined. We sought to determine the prevalence, clinical characteristics, and predictors of EV in early-stage PBC, as well as to evaluate the effectiveness of recent guidelines regarding EV screening in PBC patients. Study: We retrospectively reviewed the charts of 325 PBC patients who had undergone complete evaluation before enrollment into 2 large clinical trials at the Mayo Clinic. Results: Nineteen percent (62/325) of our patient population had EV on esophagogastroduodenoscopy; 6% (8/127) of early-stage PBC patients had EV. Ninety five percent of our PBC patients with varices met at least one of the following conditions: male sex, low albumin (<3.5 g/dL), elevated bilirubin level (≤1.2 mg/dL), and/or prolonged prothrombin time (≤12.9 s). The sensitivity and specificity of these variables in combination to predict the presence of varices were 95% and 55%, respectively. Serum bilirubin ≤1.2 mg/dL and albumin <3.5 were independent predictors of varices with hazard values of 5.4 and 3.5 respectively. Conclusions: EV can occur in a minority of early-stage PBC patients. Various models may be used to identify PBC patients who are candidates for screening esophagogastroduodenoscopy for EV. Based on adequate performance and its simplicity, we propose that male sex, low albumin, elevated bilirubin, and/or prolonged prothrombin time be used as a model to noninvasively predict EV. Further validation is required.
| Original language | English (US) |
|---|---|
| Journal | Journal of Clinical Gastroenterology |
| Volume | 45 |
| Issue number | 7 |
| DOIs | |
| State | Published - Aug 2011 |
| Externally published | Yes |
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Keywords
- esophageal varices
- esophagogastroduodenoscopy
- portal hypertension
- predictive models
- screening
ASJC Scopus subject areas
- Gastroenterology
Cite this
Varices in early histological stage primary biliary cirrhosis. / Ali, Ahmad H.; Sinakos, Emmanouil; Silveira, Marina G.; Jorgensen, Roberta A.; Angulo, Paul; Lindor, Keith.
In: Journal of Clinical Gastroenterology, Vol. 45, No. 7, 08.2011.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Varices in early histological stage primary biliary cirrhosis
AU - Ali, Ahmad H.
AU - Sinakos, Emmanouil
AU - Silveira, Marina G.
AU - Jorgensen, Roberta A.
AU - Angulo, Paul
AU - Lindor, Keith
PY - 2011/8
Y1 - 2011/8
N2 - Background/Goals: Esophageal varices (EV) in early histological stages of primary biliary cirrhosis (PBC) have been recognized but not well defined. We sought to determine the prevalence, clinical characteristics, and predictors of EV in early-stage PBC, as well as to evaluate the effectiveness of recent guidelines regarding EV screening in PBC patients. Study: We retrospectively reviewed the charts of 325 PBC patients who had undergone complete evaluation before enrollment into 2 large clinical trials at the Mayo Clinic. Results: Nineteen percent (62/325) of our patient population had EV on esophagogastroduodenoscopy; 6% (8/127) of early-stage PBC patients had EV. Ninety five percent of our PBC patients with varices met at least one of the following conditions: male sex, low albumin (<3.5 g/dL), elevated bilirubin level (≤1.2 mg/dL), and/or prolonged prothrombin time (≤12.9 s). The sensitivity and specificity of these variables in combination to predict the presence of varices were 95% and 55%, respectively. Serum bilirubin ≤1.2 mg/dL and albumin <3.5 were independent predictors of varices with hazard values of 5.4 and 3.5 respectively. Conclusions: EV can occur in a minority of early-stage PBC patients. Various models may be used to identify PBC patients who are candidates for screening esophagogastroduodenoscopy for EV. Based on adequate performance and its simplicity, we propose that male sex, low albumin, elevated bilirubin, and/or prolonged prothrombin time be used as a model to noninvasively predict EV. Further validation is required.
AB - Background/Goals: Esophageal varices (EV) in early histological stages of primary biliary cirrhosis (PBC) have been recognized but not well defined. We sought to determine the prevalence, clinical characteristics, and predictors of EV in early-stage PBC, as well as to evaluate the effectiveness of recent guidelines regarding EV screening in PBC patients. Study: We retrospectively reviewed the charts of 325 PBC patients who had undergone complete evaluation before enrollment into 2 large clinical trials at the Mayo Clinic. Results: Nineteen percent (62/325) of our patient population had EV on esophagogastroduodenoscopy; 6% (8/127) of early-stage PBC patients had EV. Ninety five percent of our PBC patients with varices met at least one of the following conditions: male sex, low albumin (<3.5 g/dL), elevated bilirubin level (≤1.2 mg/dL), and/or prolonged prothrombin time (≤12.9 s). The sensitivity and specificity of these variables in combination to predict the presence of varices were 95% and 55%, respectively. Serum bilirubin ≤1.2 mg/dL and albumin <3.5 were independent predictors of varices with hazard values of 5.4 and 3.5 respectively. Conclusions: EV can occur in a minority of early-stage PBC patients. Various models may be used to identify PBC patients who are candidates for screening esophagogastroduodenoscopy for EV. Based on adequate performance and its simplicity, we propose that male sex, low albumin, elevated bilirubin, and/or prolonged prothrombin time be used as a model to noninvasively predict EV. Further validation is required.
KW - esophageal varices
KW - esophagogastroduodenoscopy
KW - portal hypertension
KW - predictive models
KW - screening
UR - http://www.scopus.com/inward/record.url?scp=79960583434&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960583434&partnerID=8YFLogxK
U2 - 10.1097/MCG.0b013e3181f18c4e
DO - 10.1097/MCG.0b013e3181f18c4e
M3 - Article
C2 - 20856137
AN - SCOPUS:79960583434
VL - 45
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
SN - 0192-0790
IS - 7
ER -