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Similarities and differences in the clinical features between cardia varices and esophageal varices

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Zeitschriftentitel: Journal of Gastroenterology and Hepatology
Personen und Körperschaften: Kondo, Takayuki, Maruyama, Hitoshi, Kiyono, Soichiro, Sekimoto, Tadashi, Shimada, Taro, Takahashi, Masanori, Okugawa, Hidehiro, Kobayashi, Satoshi, Yoshizumi, Hiroaki, Yokosuka, Osamu
In: Journal of Gastroenterology and Hepatology, 29, 2014, 11, S. 1911-1918
Medientyp: E-Article
Sprache: Englisch
veröffentlicht:
Wiley
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Zusammenfassung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Background and Aim</jats:title><jats:p>Little is known about the clinical features of cardia varices (<jats:styled-content style="fixed-case">CV</jats:styled-content>). The aim was to examine the background, bleeding risk, and post‐treatment outcomes of <jats:styled-content style="fixed-case">CV</jats:styled-content> in patients with portal hypertension.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The subjects of this retrospective study were 277 patients (179 males, 98 females, 62.9 ± 11.5 years) with esophageal varices (<jats:styled-content style="fixed-case">EV</jats:styled-content>). In patients with CV, there were 65 bleeders, and 95 patients received endoscopic treatment for primary or secondary prophylaxis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There were 147 patients with <jats:styled-content style="fixed-case">CV</jats:styled-content> (53.1%). The higher grade of <jats:styled-content style="fixed-case">EV</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.01) and the lower grade of gastric fundal varices (<jats:styled-content style="fixed-case">FV</jats:styled-content>) (<jats:italic>P</jats:italic> = 0.046) were significant factors for the presence of <jats:styled-content style="fixed-case">CV</jats:styled-content>. Significant risk factors for bleeding were: the higher grade of <jats:styled-content style="fixed-case">EV</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.01), red sign on <jats:styled-content style="fixed-case">EV</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.01), lower albumin (<jats:italic>P</jats:italic> = 0.01), and <jats:styled-content style="fixed-case">C</jats:styled-content>hild‐<jats:styled-content style="fixed-case">P</jats:styled-content>ugh B/C (<jats:italic>P</jats:italic> &lt; 0.01) for <jats:styled-content style="fixed-case">EV</jats:styled-content> and red sign on <jats:styled-content style="fixed-case">CV</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.01) and use of non‐steroidal anti‐inflammatory drugs (<jats:styled-content style="fixed-case">NSAID</jats:styled-content>s)/aspirin (<jats:italic>P</jats:italic> &lt; 0.01) for <jats:styled-content style="fixed-case">CV</jats:styled-content>. All <jats:styled-content style="fixed-case">CV</jats:styled-content> disappeared by sclerotherapy combined with argon plasma coagulation or band ligation, and 20 patients (21.1%) in EV and 18 patients (18.9%) in CV had recurrences during the median observation period of 19.4 months. There was no significant difference in the cumulative survival rate between non‐bleeders, bleeders from <jats:styled-content style="fixed-case">EV</jats:styled-content>, and those from <jats:styled-content style="fixed-case">CV</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The <jats:styled-content style="fixed-case">CV</jats:styled-content> were closely associated with advanced grade of <jats:styled-content style="fixed-case">EV</jats:styled-content> and less‐advanced grade of <jats:styled-content style="fixed-case">FV</jats:styled-content>. Further, usage of <jats:styled-content style="fixed-case">NSAIDs</jats:styled-content>/aspirin and red sign were significantly related to the bleeding from <jats:styled-content style="fixed-case">CV</jats:styled-content>, suggesting the need for careful management.</jats:p></jats:sec>
Umfang: 1911-1918
ISSN: 0815-9319
1440-1746
DOI: 10.1111/jgh.12647