Recent guidelines from the American Association for the Study of Liver Diseases Single Topic Symposium suggest that patients with cirrhosis, including those with primary biliary cirrhosis or primary sclerosing cholangitis, should be screened for esophageal varices when the platelet count is <140 000/mm3.
Dr Heathcote and colleagues from Canada aimed to determine the validity of these guidelines in clinical practice in patients with primary biliary cirrhosis or primary sclerosing cholangitis.
The researchers retrospectively reviewed individuals undergoing screening upper endoscopy for esophageal varices at a single centre. The investigation reported esophageal varices as being present or absent.
The research team undertook endoscopic screening of a total of 235 patients with chronic liver disease between 1996 and 2001.
The researchers reported that 79 patients had primary biliary cirrhosis and 7 had primary sclerosing colangitis.
| Platelets <200 000/mm, albumin <40 g/l, and serum bilirubin >20 µmol/l are independent risk factors for esophageal varices|
The researchers also noted that 104 patients had chronic viral hepatitis and 45 presented with non-alcoholic cirrhosis of differing etiologies.
The investigators detected esophageal varices in 26 of the primary biliary cirrhosis/primary sclerosing colangitis group, 38 of the viral hepatitis group, and 21 of the "other" group.
The researchers applied multiple logistic regression analysis to the data in the group with primary biliary cirrhosis or primary sclerosing colangitis.
The research team found that platelets <200 000/mm, albumin <40 g/l, and serum bilirubin >20 µmol/l were shown to be independent risk factors for esophageal varices.
Prothrombin time was identified to be unhelpful by the researchers.
The team observed that the values at these cut offs were not useful in predicting esophageal varices in the other groups.
The investigators concluded that current guidelines recommended by the AASLD Single Topic symposium are invalid in patients with primary biliary cirrhosis and primary sclerosing colangitis.
Dr Heathcote stated that, “Patients with a platelet count <200 000/mm3, an albumin level <40 g/l, and a bilirubin level >20 µmol/l should be screened for esophageal varices.”