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Liu Z, Wei L, Ding H. Clinical characteristics of reflux esophagitis among patients with liver cirrhosis: a case-control study. Scand J Gastroenterol 2022; 57:384-391. [PMID: 34965186 DOI: 10.1080/00365521.2021.2018489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reflux esophagitis (RE) can cause esophageal varices bleeding and largely reduce life quality of liver cirrhosis (LC) patients. AIMS To clarify the prevalence, severity and risk factors of RE among LC patients. METHODS A case-control study that enrolled 420 endoscopy-confirmed LC patients with RE as a case cohort and 409 LC patients without RE as a control group was conducted. Logistic regression was used to determine the risk factors for RE among LC patients. RESULTS The 10-year cumulative incidence rate of RE was 4.79% among the LC patients. The severity of RE among the LC patients was higher than that among the non-LC patients (p<.05). The LC patients with RE patients were older (56 years vs. 53 years) and had higher rates of male patients (77.14% vs. 65.77%), smoking (46.90% vs. 32.76%), alcohol intake (50.24% vs. 41.08%), past endoscopic variceal ligation (EVL) (9.05% vs. 4.65%), endoscopic injection sclerotherapy (EIS) (16.19% vs. 2.69%), hiatus hernia (7.14% vs. 0.13%) and portal vein thrombosis (PVT) (14.05% vs. 4.01%). Logistic regression demonstrated that hiatus hernia, past EIS, PVT, smoking, white blood cell count, age, spleen thickness and platelet (PLT) count were risk factors for RE among the LC patients. CONCLUSIONS Patients with LC tended to have severer RE than non-LC patients. The special risk factors of RE among LC patients included past EIS and PVT, which deserved extra attention for hepatologists as well as gastroenterologists to prevent.
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Affiliation(s)
- Zijin Liu
- Department of Gastroenterology and Hepatology, Capital Medical University Affiliated Beijing You'an Hospital, Beijing, China
| | - Lin Wei
- Department of Gastroenterology and Hepatology, Capital Medical University Affiliated Beijing You'an Hospital, Beijing, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Capital Medical University Affiliated Beijing You'an Hospital, Beijing, China
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Khalaf M, Castell D, Elias PS. Spectrum of esophageal motility disorders in patients with liver cirrhosis. World J Hepatol 2020; 12:1158-1167. [PMID: 33442445 PMCID: PMC7772742 DOI: 10.4254/wjh.v12.i12.1158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/01/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
Abstract
Disorders of esophageal motility have been described in patients with cirrhosis in a small number of studies. In this review, we aim to provide an overview of the available evidence on esophageal motility disorders in cirrhosis and their clinical implications. This review delves into the following concepts: (1) Gastroesophageal reflux disease is common in liver cirrhosis due to many mechanisms; however, when symptomatic it is usually nocturnal and has an atypical presentation; (2) Endoscopic band ligation is better than sclerotherapy in terms of its effect on esophageal motility and seems to correct dysmotilities resulting from the mechanical effect of esophageal varices; (3) Chronic alcoholism has no major effects on esophageal motility activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy; (4) An association between primary biliary cholangitis and scleroderma can be present and esophageal hypomotility is not uncommon in this scenario; and (5) Cyclosporin-based immunosuppression in liver transplant patients can have a neurotoxic effect on the esophageal myenteric plexus leading to reversible achalasia-like manifestations.
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Affiliation(s)
- Mohamed Khalaf
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29401, United States
| | - Donald Castell
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Puja Sukhwani Elias
- Department of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29401, United States
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Tao J, Li J, Chen X, Guo Y, Tian H, Wei X, Zheng F, Wen Z, Wu B. Endoscopic Variceal Sequential Ligation Does Not Increase Risk of Gastroesophageal Reflux Disease in Cirrhosis Patients. Dig Dis Sci 2020; 65:329-335. [PMID: 31332625 PMCID: PMC6943406 DOI: 10.1007/s10620-019-05740-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic variceal sequential ligation (EVSL) is currently endorsed in our hospital, as the preferred endoscopic treatment for prevention of variceal rebleeding and achieving adequate hemostasis. There is currently a lack of consensus surrounding EVSL-induced changes in esophageal motor function and abnormal reflux. AIMS To explore alterations in esophageal motor function and risk of abnormal gastroesophageal reflux in liver cirrhosis patients with esophageal varices, after EVSL. METHODS Twenty-one liver cirrhosis patients with esophageal varices were studied using manometry and 24-h pH monitoring 1 day prior to and 1 month following EVSL. The EVSL consisted of performing esophageal variceal ligation using a multi-band ligator, which was repeated every 4 weeks until the varices were eradicated. RESULTS The amplitude and duration of peristaltic contraction waves and the percentage of abnormal esophageal contraction waveforms were unaltered in both the proximal (P > 0.05) and the distal (P > 0.05) esophagus after EVSL. However, the lower esophageal sphincter pressure was decreased following EVSL (16.1 ± 7.9 mmHg vs 21.1 ± 6.3 mmHg (P < 0.05)). Various quantitative parameters including percentage of total monitoring time with pH < 4.0, total number of reflux episodes, number of reflux episodes > 5 min, and DeMeester scores were not increased in post-EVSL patients. Abnormal reflux monitored by 24-h pH monitoring occurred in ten (47.6%) pre-EVSL patients and 11 (52.4%) post-EVSL patients. CONCLUSIONS Although EVSL affects esophageal motility by relatively decreasing LES pressure, it does not induce substantial motor abnormalities nor increase risk of abnormal gastroesophageal reflux disease in cirrhosis patients.
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Affiliation(s)
- Jin Tao
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - JianZhong Li
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - XiaoLiang Chen
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - YunWei Guo
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - Hong Tian
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - XiuQing Wei
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - FengPing Zheng
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - ZhuoFu Wen
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
| | - Bin Wu
- grid.412558.f0000 0004 1762 1794Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, 510630 Guangdong Province China
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Gastrointestinal Motility Disorders and Their Clinical Implications in Cirrhosis. Gastroenterol Res Pract 2017; 2017:8270310. [PMID: 28584525 PMCID: PMC5444003 DOI: 10.1155/2017/8270310] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022] Open
Abstract
Gastrointestinal motility is impaired in a substantial proportion of patients with cirrhosis. Cirrhosis-related autonomic neuropathy, increased nitric oxide production, and gut hormonal changes have been implicated. Oesophageal dysmotility has been associated with increased frequency of abnormal gastro-oesophageal reflux. Impaired gastric emptying and accommodation may result in early satiety and may have an impact on the nutritional status of these patients. Small intestinal dysmotility might be implicated in small intestinal bacterial overgrowth and increased bacterial translocation. The latter has been implicated in the pathophysiology of hepatic encephalopathy and spontaneous bacterial peritonitis. Enhanced colonic motility is usually associated with the use of lactulose. Pharmacological interventions aiming to alter gastrointestinal motility in cirrhosis could potentially have a beneficial effect reducing the risk of hepatic decompensation and improving prognosis.
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Bektas M, Seven G, Idilman R, Yakut M, Doğanay B, Kabacam G, Ustun Y, Korkut E, Kalkan Ç, Sahin G, Cetinkaya H, Bozkaya H, Yurdaydin C, Bahar K, Cinar K, Soykan I. Manometric assessment of esophageal motor function in patients with primary biliary cirrhosis. Eur J Intern Med 2014; 25:230-4. [PMID: 24534163 DOI: 10.1016/j.ejim.2014.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 01/17/2023]
Abstract
INTRODUCTION/AIM Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. METHOD The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. RESULTS Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mmHg): (24 vs 20, p=0.033); median esophageal contraction amplitude (mmHg): (71 vs 56, p=0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p<0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p=0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p=0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). CONCLUSION Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.
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Affiliation(s)
- Mehmet Bektas
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Gulseren Seven
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Ramazan Idilman
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Mustafa Yakut
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Beyza Doğanay
- Ankara University School of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Gökhan Kabacam
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Yusuf Ustun
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Esin Korkut
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Çağdaş Kalkan
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Günay Sahin
- Ankara University School of Medicine, Department of Immunology, Ankara, Turkey
| | - Hulya Cetinkaya
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Hakan Bozkaya
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Cihan Yurdaydin
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Kadir Bahar
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Kubilay Cinar
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Irfan Soykan
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
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Abstract
The rate of rebleeding from esophageal varices remains appreciably high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. Endoscopic therapy plays a central role in the prevention of variceal bleeding. In the 1980s sclerotherapy played a pivotal role in the prevention of variceal rebleeding, but now yields to endoscopic variceal ligation. Compared with sclerotherapy, a lower incidence of complications and rebleeding is associated with banding ligation. On the other hand, beta-blockers are also noted to be able to reduce portal pressure, leading to the reduction of variceal rebleeding. The reduction of variceal rebleeding with beta-blockers plus nitrates is as effective as banding ligation. The combination of beta-blockers and endoscopic variceal ligation has proven to be more efficacious than banding ligation alone in the reduction of variceal rebleeding and is the treatment of choice for patients with failure in either medical or endoscopic therapy. Patients with repeated rebleeding despite endoscopic therapies may require transjugular intrahepatic portosystemic stent shunt or shunt operation as a rescue therapy.
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Affiliation(s)
- Gin-Ho Lo
- Department of Medical Education, Digestive Center, E-DA Hospital, Kaohsiung County, Taiwan, Republic of China.
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Study of oesophageal motility in Egyptian cirrhotic patients before and after prophylactic endoscopic variceal ligation. Arab J Gastroenterol 2009. [DOI: 10.1016/j.ajg.2009.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Okamoto E, Amano Y, Fukuhara H, Furuta K, Miyake T, Sato S, Ishihara S, Kinoshita Y. Does gastroesophageal reflux have an influence on bleeding from esophageal varices? J Gastroenterol 2009; 43:803-8. [PMID: 18958550 DOI: 10.1007/s00535-008-2232-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 06/02/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mucosal breaks induced by gastroesophageal reflux of gastric contents were more frequently found on the right anterior wall of the lower esophagus. Bleeding from esophageal varices may be also derived from gastroesophageal reflux. The circumferential location of the ruptured esophageal varices was evaluated to elucidate the relationship between gastroesophageal reflux and variceal rupture. METHODS Between January 2004 and December 2006, 26 patients who had primary bleeding from esophageal varices and 74 patients without evidence of bleeding with positive red color signs on varices were enrolled in this study retrospectively. Locations of bleeding spots and nonbleeding red color signs of esophageal varices were retrospectively evaluated by endoscopic photographs, and the relationship between the location of red color signs and the risk of bleeding was evaluated. Other possible predictors for bleeding were also investigated by multivariate regression analysis. RESULTS Red color signs were frequently found in the right posterior wall of the lower esophagus. However, bleeding spots of esophageal varices were more frequently seen in the right anterior side (64.0%) than in others. The positive predictor for bleeding from esophageal varices was the presence of red color sign in the right anterior wall of the esophagus, and the administration of proton pomp inhibitor was the negative predictor. CONCLUSIONS Gastroesophageal acid reflex may be a risk factor of bleeding from esophageal varices. Attention should be paid to the circumferential location of red color signs in endoscopic screening of patients with esophageal varices to predict future bleeding.
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Affiliation(s)
- Eisuke Okamoto
- Department of Gastroenterology and Hepatology, Shimane University, School of Medicine, Izumo, Japan
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