A. Zaman et al., Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation, AM J GASTRO, 94(4), 1999, pp. 895-899
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.