الفهرس 
Portal hypertension and variceal bleedingOnly 14 pages are availabe for public view
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Abstract
Portal hypertension is considered among the highly morbid and fatal complication
of liver cirrhosis and it results from the combination of increased intrahepatic vascular
resistance and increased blood flow through the portal venous system. Portal hypertension
causes the development of portosystemic collaterals, among which esophageal and gastric
varices are the most relevant. Their rupture can result in variceal hemorrhage, which is
one of the most life-threatening complications of cirrhosis.
Band ligation is one of the most effective interventions for the prevention and
treatment of esophageal variceal hemorrhage. When esophageal varices are banded, local
venous occlusion and thrombosis lead to tissue necrosis at the site of the band. The band
subsequently sloughs off within about 72 h of placement and small ulceration is left at
the place of the band. Varices subsequently become smaller in diameter, reducing the risk
of life-threatening bleeding. The patient typically requires multiple treatments to
completely eradicate varices.
Variceal band ligation is preferred to sclerotherapy for bleeding varices and for
nonbleeding medium-to-large varices to decrease bleeding risk. Ligation has lower rates
of re-bleeding, fewer complications, more rapid cessation of bleeding, and a higher rate
of variceal eradication.
The study is aimed to determine the frequency of duodenal ulcer (DU), as well as
other clinical characteristics occurring after endoscopic variceal ligation (EVL) of the
esophagus.
The current study was carried out on 240 patients selected from the out patient’s
clinic of Internal Medicine Department of Monofia University hospital and to Kafr El-
Shiekh Liver Diseases Research Institute admitted to the internal department, divided into
2 groups; (group 1): included 120 patients having esophageal varices and will be treated
with band ligation, (group 2): included 120 patient having esophageal varices not
receiving band ligation as a control group.
The main results of the study revealed that:
There is no statistically significant difference between the control group and
esophageal ligation group According to demographic data of studied patients.
There is no statistically Significant difference between the control group
According to the medical history of the studied patient.
There was a statistically insignificant difference between the control group and
esophageal varices ligation group according to child score and H pylori infection.
There was a statistically insignificant difference between the control group and
EVL group regarding PHG grading.
There was statistically high significant deference between the control group and
EVL group regarding esophageal varices grading at base line
There was statistically significant defference between the control group and EVL
group regarding esophageal varices grading, PHG grading and duodenal ulcers
occurrence after 3 month follow up.
The range of occurrence of duodenal ulcers among EVL group after 3 months
follow up was 21 patients (17.5%) with duodenal ulcers and 99 patients (82.8%)
without duodenal ulcers.
There was a statistically insignificant difference among EVL group regarding
PHG grading before and after band ligation.
There was a statistically highly significant difference among the control group
regarding to PHG grading before and after 3 months follow up.
There was a statistically significant relation between duodenal ulcer and gender
among studied groups.
There was a statistically insignificant difference among EVL group regarding
relation between H. pylori infection and duodenal ulcers.
There was a statistically significant relation between duodenal ulcer and child
score among EVL group.
There was a statistically high significant relation between duodenal ulcer and
PHG grading among EVL group.
There was a statistically significant relation between duodenal ulcer and Variceal
grading among EVL patients
There was a statistical insignificant relation between duodenal ulcer and H. pylor
infection among EVL group.
There was statistically high significant relation between duodenal ulcer and the
number of ligation bands among EVL group.
There was that gender(female), Esophageal varices grade (III), PHG(moderate),
EVL and number of ligation bands were independent predictors for duodenal
ulcer.
There was a significant positive correlation between duodenal ulcer and white
blood cells,urea, creatinine, ALT, and direct bilirubin.
Based on our results we recommend further studies on larger patients and a longer period of follow-up to emphasize our conclusion.