A study on non invasive predictors of large esophageal varices using clinical, laboratory and imaging parameters.

Portal hypertension- a major hallmark of cirrhosis is defined as a portal pressure gradient exceeding 5-10 mm Hg. In portal hypertension, portosystemic collaterals decompress the portal circulation and give rise to varices. Development of esophageal varices and gastrointestinal bleeding represents a serious consequence in patients with portal hypertension. At the time of diagnosis of liver cirrhosis, esophageal varices are present in about 40% of patients with compensated disease and in 60% of those with decompensated disease and ascites. In patients with liver cirrhosis who do not have detectable esophageal varices, the latter appear at a rate of nearly 5% per year. Also, the size of varices tends to increase with time. It has been estimated that among those with small esophageal varices, nearly 12% progress to large varices annually. The annual incidence of first variceal bleeding has been estimated to be around 4% in non-selected patients with cirrhosis of the liver who have not bled previously. It has been shown that the risk of variceal bleeding is related to the size of esophageal varices, 8 with large esophageal varices being at a greater risk; this is possibly due to a higher variceal wall tension in large esophageal varices. Thus, annual incidence of gastrointestinal bleeding is only 1–2% in patients without varices, 5% in those with small esophageal varices and 15–20% in patients with large esophageal varices.