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Esophageal Varices

Esophageal Varices: A serious condition involving the abnormal dilataion and tortuous enlargement of blood vessels in the esophagues.
This can lead to life-threatening bleeding.
Identifying the most effective approaches for managing Esophageal Varices is critical for improving patient outcomes.
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Most cited protocols related to «Esophageal Varices»

Between January 2004 and September 2006, consecutive patients with cirrhosis but no detectable hepatocellular carcinoma (HCC) were prospectively identified and entered into a surveillance programme using ultrasound and α-fetoprotein (AFP), as has been previously described in greater detail.6 (link) Patients were enrolled if they had a Child-Pugh class A or B cirrhosis and absence of known HCC at the time of initial evaluation. Patients diagnosed with HCC within the first 6 months of enrolment (prevalent cases) were excluded. Other exclusion criteria included clinical evidence of significant hepatic decompensation (refractory ascites, grades 3 and 4 encephalopathy, active variceal bleeding or hepatorenal syndrome), comorbid medical conditions with a life expectancy of less than 1 year, prior solid organ transplant and a known extrahepatic primary tumour. Patients were followed until the time of HCC diagnosis, liver transplantation, death or until the study was terminated on 31 July 2010.
The following demographic and clinical data were collected at the time of enrolment: age, gender, race, body mass index (BMI), medical history, lifetime alcohol use and lifetime tobacco use. Data regarding their liver disease included the underlying aetiology and presence of ascites, encephalopathy or oesophageal varices. Laboratory data of interest at the time of enrolment included platelet count, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, bilirubin, albumin, international normalised ratio (INR) and AFP. This data set was used as the basis of a published predictive model to identify patients with hepatocellular carcinoma with a c statistic of 0.70.2
Publication 2013
Albumins Alkaline Phosphatase alpha-Fetoproteins Ascites Aspartate Transaminase Bilirubin Child D-Alanine Transaminase Diagnosis Encephalopathies Esophageal Varices Gender Hepatocellular Carcinomas Hepatorenal Syndrome Index, Body Mass International Normalized Ratio Liver Cirrhosis Liver Diseases Liver Transplantations Neoplasms Patients Platelet Counts, Blood Transplant, Organ Ultrasonography
We performed a retrospective cohort study using data from the Veterans Health Administration (VHA), specifically focused on Veterans whose data had been collected as part of the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) study group. This database was selected because the VHA is the largest single provider of liver care in the United States (US), and is the largest nationally-representative dataset of patients with chronic liver disease including inpatient and outpatient clinical, laboratory, and prescription data. The VOCAL cohort has also been used for numerous prior studies focused on patients with chronic liver disease,13 (link)–16 (link) and is very representative of the United Network for Organ Sharing (UNOS) liver transplant distribution from an etiology standpoint (Supplemental Figure 1).17 The derivation of the VOCAL dataset has been previously described,18 (link) but in brief, the VHA relational database contains a range of detailed demographic, clinical, laboratory, imaging, pharmacy, admissions, financial, and administrative coding data. For this study, nearly ~129,000 patients with incident cirrhosis were identified in the VHA system between 2008 and 2016 using a validated algorithm with one inpatient or two outpatient International Classification of Disease (ICD)-9 cirrhosis codes (571.2 or 571.5) or adapted ICD-10 codes.19 (link) Mortality data was obtained from the Vital Status File, and transplantation outcomes were cross-referenced from the UNOS Standard Transplant Analysis and Research (STAR) data file. For each patient, a six-month baseline period from the time of cirrhosis diagnosis was established over which selection criteria were applied. We included patients aged ≥18 years who were actively engaged in care within the VHA, defined as completion of two or more outpatient visits, consistent with prior methods.16 (link), 20 (link), 21 (link) We excluded patients with decompensated cirrhosis who by definition cannot be classified as having ACLF per the APASL criteria, using a validated algorithm that includes one inpatient or two outpatient ICD-9/ICD-10 codes for ascites, bleeding esophageal varices, or hepatic encephalopathy.22 (link) Based on the bilirubin criteria for APASL ACLF, patients were also excluded if they had a baseline total bilirubin ≥5mg/dL (with at least two values checked in the baseline period). Finally, patients were excluded if they died within the baseline period, received liver transplantation prior to or within the baseline period, or did not have follow-up data beyond the baseline period.
Publication 2019
Ascites Bilirubin Clinical Laboratory Services Diagnosis Disease, Chronic Esophageal Varices Hepatic Encephalopathy Inpatient Liver Liver Cirrhosis Liver Diseases Liver Transplantations Organ Transplantation Outpatients Patient Representatives Patients Transplant, Organ Transplantation Veterans
The primary outcomes of cirrhosis, decompensated cirrhosis and HCC were defined using relevant physician visit, emergency department visit, hospital diagnosis, procedure, death and pathology codes (Table 1). A secondary outcome of 2-year all-cause mortality following last clinic visit was reported as an overall measure of patient severity of illness.
We built a series of diagnostic algorithms for each outcome ranging from simple (e.g. a single physician visit code) to more complex. This was done to identify the most parsimonious algorithms that were also highly sensitive and/or specific. We aimed to utilize all available health administrative data, and include both hospital-based and outpatient physician visits in our algorithms. Data sources were searched for relevant codes ten years prior to two years following the date of last clinical assessment (up to March 31st, 2014 for TCLD and August 31st, 2013 for KHSC).
Cirrhosis algorithms ranged from cirrhosis codes only to combinations with codes for chronic liver disease or any complication (decompensation events, HCC or liver transplant). Algorithms were combined in such a way as to make them more sensitive (“or” combinations) or specific (“and” combinations). As physician visit codes were noted to be less specific, we aimed to increase specificity by combining two or more such codes with hospitalization codes.
Decompensation algorithms included hospital diagnostic and death codes for portal hypertension, hepatorenal syndrome, jaundice, hepatic coma, hepatic failure, bleeding esophageal varices, gastric varices (bleeding not specified), and ascites. There were no physician visit codes available for decompensation events. We included procedure codes for endoscopy or insertion of Sengstaken tube for upper gastrointestinal bleeding, transjugular intrahepatic portosystemic shunt, and paracentesis. Since several of these procedures could occur for reasons other than decompensated cirrhosis (such as bleeding from an ulcer, or ascites secondary to an extra-hepatic malignancy), we tested combinations of procedure codes with a cirrhosis code from a physician visit.
Hepatocellular carcinoma algorithms ranged from simple (a single physician visit code) to more complex. We tested several combinations in order to optimise both sensitivity and specificity. We combined physician visit codes, hospital diagnostic codes, and cause of death codes. Further, we included procedure codes for radiofrequency ablation. Since this procedure can also be used to ablate tumours outside the liver (e.g., renal tumours), we combined ablation codes with an outpatient code for cirrhosis. Finally, we tested our results with and without anatomical and pathology codes from the Ontario Cancer Registry.
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Publication 2018
Ascites Cancer of Liver Clinic Visits Diagnosis Disease, Chronic Endoscopy Esophageal Varices Gastric Varix Hepatic Coma Hepatic Insufficiency Hepatocellular Carcinomas Hepatorenal Syndrome Hospitalization Icterus Kidney Neoplasm Liver Liver Cirrhosis Liver Transplantations Malignant Neoplasms Neoplasms Outpatients Paracentesis Patients Physicians Portal Hypertension Radiofrequency Ablation Shunt, Transjugular Intrahepatic Portosystemic Ulcer Upper Gastrointestinal Tract
Patients admitted over a period of one year (from May 2013 to May 2014) to the ICU of the University of Bari Academic Hospital were considered for enrollment in the study. The local ethics committee (Azienda Ospedaliero-Universitaria Policlinico di Bari Ethic Committee, protocol number: 257/C.E. March 2013) approved the investigative protocol, and written informed consent was obtained from each patient or next of kin. A physician not involved in the study was always present for patient care. Our clinical trial was registered with clinicalTrials.gov, identifier: NCT02473172.
Patients were eligible for the study if they were older than 18 years, oro-tracheally or naso-tracheally intubated, had been ventilated for acute respiratory failure with CMV (flow-limited, pressure-limited or volume-targeted pressure-limited) for at least 72 hours consecutively and were candidates for assisted ventilation. The criteria for defining the readiness to assisted ventilation were: a) improvement of the condition leading to acute respiratory failure; b) positive end-expiratory pressure (PEEP) lower than 10 cmH2O and inspiratory oxygen fraction (FiO2) lower than 0,5; c) Richmond agitation sedation scale (RASS) score between 0 and –1 [23 (link)] obtained with no or moderate levels of sedation and, d) ability to trigger the ventilator, i.e., to decrease pressure airway opening (PAO) >3–4 cmH2O during a brief (5–10 s) end-expiratory occlusion test. Other criteria included hemodynamic stability without vasopressor or inotropes (excluding a dobutamine and dopamine infusion <5 gamma/Kg/min and 3 gamma/Kg/min, respectively) and normothermia. Patients were excluded from the study if they were affected by neurological or neuromuscular pathology and/or known phrenic nerve dysfunction, or if they had any contraindication to the insertion of a nasogastric tube (for example: recent upper gastrointestinal surgery, esophageal varices).
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Publication 2016
Conscious Sedation Dental Occlusion Dobutamine Dopamine Esophageal Varices Ethics Committees Exhaling Gamma Rays Gastrointestinal Surgical Procedure Hemodynamics Inhalation Inotropism Intubation, Nasogastric Oxygen Patients Phrenic Nerve Physicians Positive End-Expiratory Pressure Precipitating Factors Pressure Regional Ethics Committees Respiratory Failure Sedatives Vasoconstrictor Agents
We conducted a prospective cohort study at University of North Carolina from July, 2011 through December, 2013. Consecutive adult patients (age 18-80 years) undergoing routine outpatient esophagogastroduodenoscopy (EGD) were approached if they had upper GI symptoms suggestive of esophageal dysfunction (e.g. dysphagia, food impaction, heartburn, reflux, chest pain). Subjects provided informed consent, including consent for future use of stored specimens, and were enrolled prior to the endoscopy. Subjects were excluded if they had a known (prevalent) diagnosis of EoE or a different eosinophilic gastrointestinal disorder (EGID), GI bleeding, active anticoagulation, known esophageal cancer, prior esophageal surgery, known esophageal varices, medical instability or multiple comorbidities precluding enrollment in the clinical opinion of the endoscopist, or inability to read or understand the consent form. This study was approved by the UNC Institutional Review Board and registered on clinicaltrials.gov (NCT 01988285).
Cases were diagnosed with EoE if they met consensus guidelines (1 (link)-3 (link)). Specifically, they were required to have at least one typical symptom of esophageal dysfunction; at least 15 eosinophils per high-power field (eos/hpf) on esophageal biopsy persisting after an 8 week PPI trial (20-40 mg twice daily of any of the available agents, prescribed at the discretion of the clinician); and other causes of esophageal eosinophilia excluded. Of note, baseline data for the EoE cases were obtained after the PPI trial, at the time of the confirmatory EGD, but prior to receiving the histologic results confirming the diagnosis or provision of EoE-specific treatment, so as to minimize potential recall bias. Controls were subjects who, after endoscopy and biopsy, did not meet clinical or histologic criteria for EoE. Subjects with PPI-responsive esophageal eosinophilia (PPI-REE) were not included in this study.
Clinical data were collected using a standardized case report form. Items recorded included demographics, symptoms, concomitant atopic diseases, indications for endoscopy, and endoscopic findings. Food allergy data was collected by patient self-report on a prospectively administered questionnaire, and could therefore include both food allergies and sensitizations. Systematic allergy testing was not a component of this study. During endoscopy, research-protocol esophageal biopsies were obtained (two from the proximal, one from the mid, and two from the distal esophagus) to maximize EoE diagnostic sensitivity (30 (link), 31 ). Gastric and duodenal biopsies were also collected for research purposes to exclude concomitant eosinophilic gastroenteritis. Additional clinical biopsies were taken as indicated at the discretion of the endoscopist. Esophageal eosinophil counts were quantified by the study pathologists using our previously validated methods (32 (link)). In brief, slides were masked to case/control status, digitized, and reviewed with Aperio ImageScope (Aperio Technologies, Vista, CA). Five microscopy fields from each of the five biopsies were examined to determine the maximum eosinophil density (eosinophils/mm2 [eos/mm2]). So results could be compared to prior studies, eosinophil density was converted to an eosinophil count (eos/hpf) using a hpf size of 0.24 mm2, the most commonly reported field size in the literature (33 (link)).
EoE cases were treated for 8 weeks as clinically indicated with topical corticosteroids (either oval viscous budesonide 1 mg twice daily or fluticasone from a multi-dose inhaler, 880 mcg twice daily) (34 (link)-36 (link)). At the end of the treatment period, repeat upper endoscopy with biopsy was performed, with collection of a second set of blood and tissue samples as noted above. A second blood sample was also collected for a subset of control subjects at least 2 months after baseline samples were collected to assess for stability in biomarkers over time.
Publication 2015
Adrenal Cortex Hormones Adult Biological Markers Biopsy BLOOD Budesonide Chest Pain concomitant disease Deglutition Disorders Diagnosis Duodenum Endoscopy Endoscopy, Gastrointestinal Eosinophil Eosinophilia Eosinophilic gastroenteritis Esophageal Diseases Esophageal Neoplasms Esophageal Varices Esophagogastroduodenoscopy Esophagus Ethics Committees, Research Fluticasone Food Food Allergy Heartburn Hypersensitivity Impacted Tooth Inhaler Mental Recall Microscopy Operative Surgical Procedures Outpatients Pathologists Patients Stomach Tissues Viscosity

Most recents protocols related to «Esophageal Varices»

Patients over 18 years old admitted to the hospital complex with signs and symptoms of UGIB and diagnosed by upper digestive endoscopy (UDE) or surgical intervention (laparoscopy) were determined as our study group.
UGIB was defined as: i) presence of endoscopically proven ulcers, perforation, or hemorrhagic erosions and ii) presence of dark or “coffee grounds” vomiting, melena, hematemesis, hematochezia, epidegastric pain, sudden loss, heavy sweating, and/or pallor.
Patient exclusion criteria were (i) bleeding from gastric or esophageal varices or neoplasm; (ii) presence of cirrhosis, Mallory-Weiss tears, and/or Dieulafoy lesions; (iii) serious health condition; (iv) UDE performed after 48 h of hospital admission; (v) hospitalization within 15 days prior to the current hospital admission; and (vi) in-hospital UGIB.
For each recruited case participant, controls were matched by sex, age (±5 years), and recruitment data (3 months). Control participants were admitted to preoperative units of the same hospital complex for mild surgery unrelated to gastrointestinal disorders (i.e., inguinal/umbilical hernia correction; plastic surgery; phacectomy (eye cataract); and prostatectomy).
Participants were recruited regardless of the use of NSAIDs and LDA in order to verify whether the proposed genetic variants are associated with the risk of UGIB or whether there is synergism between the variants and the use of these drugs in the risk of UGIB. Hence, it is essential that both case and control groups include NSAIDs or LDA-exposed and NSAIDs or LDA-unexposed individuals to assess the likely direct effect of functional variants on risk of suffering UGIB (7 (link)).
In order to reduce possible bias, only biologically unrelated participants were included. Participants with history of neoplasia, immunodeficiency syndrome, coagulopathies, nasogastric or percutaneous tube holders; patients who use narcotics; and non-residents of the study region for at least 3 months were excluded.
The inclusion and exclusion criteria for the participants are described in detail in our three previous studies (4 (link), 10 (link), 11 (link)).
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Publication 2023
Anti-Inflammatory Agents, Non-Steroidal Blood Coagulation Disorders Cataract Coffee Esophageal Varices Esophagogastroduodenoscopy Exomphalos Gastrointestinal Diseases Genetic Diversity Groin Hematemesis Hematochezia Hernia, Inguinal Hospitalization Immunologic Deficiency Syndromes Laparoscopy Liver Cirrhosis Mallory-Weiss Syndrome Melena Narcotics Neoplasms Operative Surgical Procedures Pain Patients Pharmaceutical Preparations Plastic Surgical Procedures Prostatectomy Stomach Ulcer Umbilicus
Information regarding patient characteristics, including demographics, clinical comorbidities, and medication use was ascertained for each patient during the baseline assessment period. Clinical characteristics included age, sex, calendar year, severity of cirrhosis (defined by prior decompensation events, including ascites, spontaneous bacterial peritonitis, bleeding esophageal varices, hepatic encephalopathy, and hepatorenal syndrome), coagulopathy, thrombocytopenia, prior bleeding events, chronic kidney disease or end‐stage renal disease (CKD/ESRD), CHA2DS2VASc score (calculated as 1 point each for congestive heart failure, hypertension, age ≥75 [point doubled], diabetes, prior stroke or transient ischemic attack or thromboembolism [point doubled], vascular disease, age 65–74, female sex), and HAS‐BLED score (calculated as 1 point each for hypertension, abnormal renal function, abnormal liver function or cirrhosis [all patients received this point], prior stroke, prior major bleeding or predisposition to bleeding, a labile international normalized ratio, age >65 years, prior alcohol or drug use history, or use of medications that predispose to bleeding).14, 26 All comorbidities were identified by ICD‐9 and ICD‐10 codes (see Table S1 for details).
Within the study cohort, the primary outcome was prescription of an OAC (including warfarin and the individual DOACs, apixaban, rivaroxaban, or dabigatran) in the 6 months following (and including) the cohort entry date, between 2012 and 2019.
Publication 2023
apixaban Ascites Bacteria Blood Coagulation Disorders Cerebrovascular Accident Chronic Kidney Diseases Congestive Heart Failure Dabigatran Diabetes Mellitus Esophageal Varices Ethanol Females Hepatic Encephalopathy Hepatorenal Syndrome High Blood Pressures International Normalized Ratio Kidney Kidney Failure, Chronic Liver Cirrhosis Patients Peritonitis Pharmaceutical Preparations Rivaroxaban Thrombocytopenia Thromboembolism Transient Ischemic Attack Vascular Diseases Warfarin
Adults ≥18 years of age were eligible for the trial, if they had a history of repeatedly occurring episodes of heartburn for at least 6 months (RDQ score ≥8 in the dimension ‘heartburn’). An upper GI endoscopy within 5 years before screening excluded relevant erosive disease (reflux oesophagitis LA classification grades B–D) and other severe GI diseases including malignancies, ulcer, Barrett’s oesophagus and oesophageal varices (see online supplemental methods for inclusion/exclusion criteria and explanation of interval between endoscopy and screening). Eligible patients provided written informed consent before enrolment.
Publication 2023
Adult Barrett Esophagus Endoscopy Esophageal Varices Esophagogastroduodenoscopy Gastrointestinal Diseases Heartburn Malignant Neoplasms Patients Peptic Esophagitis Ulcer
All the extracted personal information of the patients was deidentified. The demographic features used for the machine learning models included age, sex, height, weight, and body mass index (BMI). The laboratory features include serum creatinine (Cr), blood urea nitrogen (BUN), fasting glucose, random glucose, glycated hemoglobin (HbA1c), spot urine protein to creatinine ratio (UPCR), spot urine albumin to creatinine ratio (UACR), hemoglobin (HGB), hematocrit (HCT), albumin, total protein, aspartate aminotransferase (AST), alanine transaminase (ALT), creatine phosphokinase (CPK), high-sensitivity C-reactive protein (hsCRP), serum sodium (Na), serum potassium (K), red blood count (RBC), white blood count (WBC), platelet, total bilirubin (Bil-T), uric acid (UA), total cholesterol (CHO), low-density lipoprotein (LDL), and triglyceride (TG). The comorbidities were extracted according to the ICD-9 or ICD-10 codes and included diabetic retinopathy, hypertension, coronary arterial disease (CAD), stroke, peripheral arterial disease (PAD), congestive heart failure (CHF), acute kidney injury (AKI), liver cirrhosis, cancer, bacteremia, sepsis, shock, peritonitis, ascites, and bleeding esophageal varices.
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Publication 2023
Alanine Transaminase Albumins Ascites Bacteremia Bilirubin BLOOD Blood Platelets Cerebrovascular Accident Cholesterol Congestive Heart Failure Coronary Artery Disease C Reactive Protein Creatine Kinase Creatinine Diabetic Retinopathy Erythrocyte Count Esophageal Varices Glucose Hemoglobin Hemoglobin, Glycosylated High Blood Pressures Index, Body Mass Kidney Injury, Acute Liver Cirrhosis Low-Density Lipoproteins Malignant Neoplasms Patients Peripheral Vascular Diseases Peritonitis Potassium Proteins Septicemia Serum Shock Sodium Transaminase, Serum Glutamic-Oxaloacetic Triglycerides Urea Nitrogen, Blood Uric Acid Urine
Subjects who underwent the upper endoscopy were recruited from two hospitals as follows: (1) Suzhou: The First Affiliated Hospital of Soochow University and (2) Jintan: Affiliated Hospital of Jiangsu University, between 2015 and 2021. In the two centers, subjects were excluded if they have (1) esophagitis of other etiologies, e.g., pills-induced esophagitis, eosinophilic, radiation, and infectious esophagitis; (2) esophageal varices; (3) esophageal squamous cell cancer. This study was approved by the Ethics Committee of The First Affiliated Hospital of Soochow University and conducted in accordance with the Helsinki Declaration of 1975 as revised in 2000 (the IRB approval number 2022098). All participants signed statements of informed consent before inclusion. Besides, the Z-line endoscopic images were also obtained from an open dataset, HyperKvasir, which now is the largest dataset of the gastrointestinal endoscopy (https://datasets.simula.no/hyper-kvasir/) [12 (link)]. The dataset offers labeled/unlabeled/segmented image data and annotated video data from Bærum Hospital in Norway. The characteristic of the datasets was shown in Figure 1. Each endoscopic image of Z-line was determined and labeled as normal, LA classification A + B (LA A + B), or LA classification C + D (LA C + D) by three rich-experienced endoscopists, based on the LA classification. The endoscopic devices in our hospital include Olympus GIF-Q260, GIF-H290, and Fuji EG-601WR, while in the HyperKvasir dataset, they include Olympus and Pentax at the Department of Gastroenterology, Bærum Hospital.
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Publication 2023
Contraceptives, Oral Endoscopes Endoscopy Endoscopy, Gastrointestinal Eosinophilia Esophageal Squamous Cell Carcinoma Esophageal Varices Esophagitis Ethics Committees, Clinical Glycyrrhetinic Acid Infection Radiation

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More about "Esophageal Varices"

Esophageal Varices (EVs) are a serious medical condition involving the abnormal dilation and tortuous enlargement of blood vessels in the esophagus.
This can lead to life-threatening bleeding, making it critical to identify the most effective approaches for managing this condition.
PubCompare.ai is an innovative tool that can help optimize your research on Esophageal Varices by enhancing reproducibility and accuracy.
The FibroScan is a non-invasive diagnostic tool used to assess the stiffness of the liver, which can be a contributing factor to Esophageal Varices.
PH paper test strips are also sometimes used to measure the acidity of the esophagus, which can provide insights into the underlying causes of Esophageal Varices.
Statistical software like SPSS version 18.0, PASW Statistics version 18.0, and Statistical Analysis Software 9.4 can be utilized to analyze data related to Esophageal Varices, while the ADVIA Centaur XP Immunoassay System and HX-610-135 are laboratory instruments that may be used to measure relevant biomarkers.
MATLAB 2015a is a programming environment that can be employed for modeling and simulations related to Esophageal Varices.
Diprivan, a sedative and hypnotic agent, may be used in the management of Esophageal Varices, particularly during procedures such as endoscopic variceal ligation (EVL) using a Pneumatic EVL device.
By leveraging these tools and technologies, researchers can optimize their efforts to identify the most effective approaches for managing Esophageal Varices and improving patient outcomes.