Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation

OBJECTIVE: The incidence of esophageal and gastric varices and portal hyper tensive gastropathy (PHG) has been well studied in cirrhotic patients. Beca use little is known of the prevalence of other upper and lower gastrointest inal tract pathology in pre-liver transplant candidates, we retrospectively studied the prevalence of and factors associated with these findings. METHODS: One hundred and twenty pre-liver transplant candidates underwent e sophagogastroduodenoscopy to evaluate for varices, and 71 of them also unde rwent flexible sigmoidoscopy to screen for colorectal carcinoma. The associ ation of upper and lower GI tract pathology with Child-Pugh Class, etiology of cirrhosis, and signs of portal hypertension, including presence and siz e of esophageal varices, presence of gastric varices, PHG, ascites, and spl enomegaly, was analyzed using univariate and multivariate analysis. RESULTS: Etiology of cirrhosis among 87 men and 33 women (mean age, 52 yr) included 25% hepatitis C, 27% hepatitis C/alcohol, 15% alcohol, 10% primary sclerosing cholangitis/primary biliary cirrhosis, 9% cryptogenic, 8% metab olic, and 6% hepatitis B. Prevalence of Child-Pugh Classes A, B, and C were 34%, 49%, and 17%, respectively; 73% of patients had esophageal varices (2 3% were large), 62% PHG (23% were severe), and 16% gastric varices. Excludi ng varices and PHG, endoscopic findings in the upper GI tract (n = 120) inc luded: 13% esophagitis/ulcers, 7.5% gastritis, 8% duodenitis, 2% Barrett's esophagus, 3% duodenal ulcers, and 2% gastric ulcers. Findings in the lower gastrointestinal tract (n = 71) included 21% adenomatous polyps, 21% inter nal hemorrhoids, 15% diverticulosis, 7% rectal varices, 3% colopathy, and 3 % vascular ectasias. Univariate analysis revealed that there was a signific ant association between rectal varices and severe PHG (p < 0.05). This asso ciation was not maintained when multivariate analysis was performed. CONCLUSIONS: Among all the findings, only rectal varices and colopathy were of higher prevalence in the pre-liver transplant population than that repo rted for the general population. No significant associations were found bet ween these gastrointestinal tract lesions and patient characteristics. (C) 1999 by Am. Cell. of Gastroenterology.