Diagnosis and monitoring of portal hypertension

R. de Franchis, A. Dell'Era, M. Primignani

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Currently, oesophago-gastroduodenoscopy is the standard method to diagnose the presence of oesophago-gastric varices and to estimate the risk of bleeding. It is recommended that all patients undergo endoscopic screening for varices at the time when cirrhosis is diagnosed. After screening endoscopy, patients with medium or large varices should be treated to prevent bleeding, while all other patients should undergo periodic surveillance endoscopy. However, at a given point in time a variable proportion of patients will not have varices, since the prevalence of varices is variable. Thus, screening all cirrhotic patients with endoscopy to detect the presence of varices implies a number of unnecessary endoscopies. In recent years a wealth of new methods have been proposed as alternatives to conventional oesophago-gastroduodenoscopy for the non-invasive or minimally invasive diagnosis of oesophageal varices. Three of these methods (the platelet count/spleen diameter ratio, Fibrotest and Fibroscan) are truly non-invasive. Of these, the former is promising and needs a proper validation, Fibrotest appears to be insufficiently precise, while Fibroscan needs further evaluation. Multidetector CT oesophagography and capsule endoscopy are not entirely "non-invasive", since the first requires air insufflation into the oesophagus via an orally passed tube, and the latter requires swallowing the capsule. Multidetector CT oesophagography is promising, but needs further evaluation; capsule endoscopy is safe and reliable and might be proposed as an alternative to oesophago-gastroduodenoscopy in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.

Original languageEnglish
Pages (from-to)312-317
Number of pages6
JournalDigestive and Liver Disease
Volume40
Issue number5
DOIs
Publication statusPublished - May 2008

Fingerprint

Portal Hypertension
Varicose Veins
Endoscopy
Capsule Endoscopy
Esophageal and Gastric Varices
Hemorrhage
Insufflation
Deglutition
Platelet Count
Esophagus
Capsules
Fibrosis
Spleen
Air

Keywords

  • Biochemical parameters
  • Capsule endoscopy
  • Diagnosis
  • Endoscopy
  • Multidetector CT oesophagography
  • Non-invasive methods
  • Oesophageal varices
  • Portal hypertension
  • Transient elastograph

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Diagnosis and monitoring of portal hypertension. / de Franchis, R.; Dell'Era, A.; Primignani, M.

In: Digestive and Liver Disease, Vol. 40, No. 5, 05.2008, p. 312-317.

Research output: Contribution to journalArticle

de Franchis, R. ; Dell'Era, A. ; Primignani, M. / Diagnosis and monitoring of portal hypertension. In: Digestive and Liver Disease. 2008 ; Vol. 40, No. 5. pp. 312-317.
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