Factors Associated With Bleeding Secondary to Rupture of Esophageal Varices in Children and Adolescents With Cirrhosis

ABSTRACT Objective: Bleeding of esophageal varices is the main cause of morbidity and mortality in children with portal hypertension. It is important to understand the factors related with a bleeding episode to evaluate more effective primary prophylaxis. The present study aims to describe the endos...

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Published in:	Journal of pediatric gastroenterology and nutrition Vol. 64; no. 2; pp. e44 - e48
Main Authors:	Pimenta, Júlio R., Ferreira, Alexandre R., Fagundes, Eleonora D.T., Queiroz, Thaís C.N., Baptista, Regiane A.N., Araújo Moreira, Eduardo G., Resende, Camilo B., Bittencourt, Paulo F.S., Carvalho, Simone D., Neto, José A.F., Penna, Francisco J.
Format:	Journal Article
Language:	English
Published:	United States by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology 01-02-2017
Subjects:	Adolescent Child Child, Preschool children and adolescents Cross-Sectional Studies Esophageal and Gastric Varices - diagnosis Esophageal and Gastric Varices - etiology esophageal varices Female Gastrointestinal Hemorrhage - diagnosis Gastrointestinal Hemorrhage - etiology Humans Hypertension, Portal - etiology Liver Cirrhosis - complications Logistic Models Male Multivariate Analysis portal hypertension Risk Factors upper gastrointestinal bleeding
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Summary:	ABSTRACT Objective: Bleeding of esophageal varices is the main cause of morbidity and mortality in children with portal hypertension. It is important to understand the factors related with a bleeding episode to evaluate more effective primary prophylaxis. The present study aims to describe the endoscopic and laboratory findings associated with upper gastrointestinal bleeding (UGIB) secondary to esophageal varices. Method: A cross‐sectional study with 103 children and adolescents with cirrhosis, divided into a group that had experienced an episode of upper UGIB (35 patients) and a group without a history of UGIB (68 patients), was carried out. The esophageal and gastric varices were classified, and the portal hypertensive gastropathy, laboratory findings, and Child‐Pugh classification were measured. Results: Factors observed in univariate analysis to be associated with UGIB were the presence of esophageal varices of medium caliber or larger, portal hypertensive gastropathy, presence of red spots on esophageal varices, Child‐Pugh class B or C, and hypoalbuminemia (P < 0.05). After multivariate logistic regression analysis, the significant factors were the presence of red spots on esophageal varices and the presence of gastric varices. When separated the autoimmune hepatitis, nonbiliary atresia patients (all patients except the patients with biliary atresia), and biliary atresia groups the findings in the univariate analysis were the presence of esophageal varices of medium or larger caliber, presence of red spots on varices, and presence of gastric varices in the autoimmune hepatitis patients and nonbiliary atresia patients and presence of red spots on esophageal varices, presence of gastric varices, and Child‐Pugh classification B or C in biliary atresia group (P < 0.05). After multivariate logistic regression analysis, no statistical significance was found for any factor analyzed in any groups. Conclusions: The presence of gastric varices and red spots on esophageal varices were related to episodes of UGIB secondary to rupture of esophageal varices. When these findings are observed, indications for endoscopic primary prophylaxis should be evaluated. More studies are, however, necessary to better understand this problem.
Bibliography:	The authors have no conflicts of interest. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0277-2116 1536-4801
DOI:	10.1097/MPG.0000000000001362