Two findings of portal hypertension: Evaluation of correlation between serum-ascites albumin gradient and esophageal varices in non-alcoholic cirrhosis

Abstract

Öz:Amaç: Özofagus varisleri ve serum asit albumin gradiyenti (SAAG) portal hipertansiyonun önemli iki bulgusudur. Son yıllarda alkole bağlı siroz hastalarında bu iki bulgu arasında korelasyon gösterilse de nonalkolik siroz vakalarına ait veri azdır. Yöntem: Ocak 2002-Haziran 2003 tarihleri arasında asit tespit edilen 45 nonalkolik sirozlu hastada serum ve asit albumin ölçümleri yanında özofagus varisleri değerlendirildi. Bulgular: 45 hastadan 32'si erkek, 13'i kadındı. Ortalama yaş 56.3 ±12.5, yaş aralığı 22-85 arasında bulundu. 35 hastada etken hepatitis B, 6 hastada Hepatitis C tespit edilirken 4 hastada etyoloji saptanamadı. Olgularda serum albumin düzeyi 2.53±0.53 gri di, asit albumin düzeyi 0.42±0.31 gri di, SAAG 2.1±0.51 bulundu. Endoskopik özofagus incelemesinde 4 olguda varis görülmezken 15 olguda birinci derece, 18 olguda ikinci derece, 8 olguda üçüncü derece varis görüldü. Özofagus varis derecesi ile serum albumini (p-0.7) ve SAAG (p-0.2) arasında korelasyon yoktu, asit albumini ile çok zayıf da olsa korelasyon bulundu (p=0.03, r=0.30). Ayrıca SAAG değerlerine göre olgular sınıflandırılarak varisleri değerlendirildi. SAAG 1.1-1.49 arasındaki 4 olgunun 2'sinde varis vardı, SAAG 1.5-1.99 arasındaki 15 olgudan 13'inde varis vardı, SAAG 2'nin üzerinde olan olguların ise tümünde varis vardı. Sonuç: Tüm non alkolik siroz olgularımızda literatürü destekler şekilde SAAG 1.1 değerinin üzerindedir. Alkole bağlı siroz hastalarında özofagus varisleri ile arasındaki korelasyon, nonalkolik sirozlu hastalarımızda gösterilememiştir. Asit tespit ettiğimiz 45 nonalkol sirozlu hastanın 4'inde varis olması, SAAG 2.0' nin üzerinde olan tüm olgularda özofagus varislerinin bulunması da dikkat çekicidir.

Abstract:Background/aims: Esophageal varices and serum-ascites albumin gradient (SAAG) are two major findings of portal hypertension. Recently, correlation between these two findings in patients with cirrhosis due to alcohol has been attracted attention. We aimed at evaluating whether a correlation exists between these parameters in the patients with non-alcoholic cirrhosis. Methods: Albumin levels in the serum and ascites and esophageal varices were studied and the correlation between these parameters was assessed in 45 patients with non-alcoholic cirrhosis detected between January 2002 and June 2003. Results: Thirty-two of the patients were male and 13 female. The average age of the patients was 56.3±12.5 years (range 22-85 years). The causative agents were found to be hepatitis B virus in 35 patients and hepatitis C virus in six patients; no etiology could be determined in the remaining four patients. Serum level of albumin was determined as 2.53±0.53 g/dl, ascites level of albumin as 0.42±0.31 g/dl and SAAG as 2.1±0.51. ndoscopic esophageal examination revealed first-degree esophageal varices in 15 patients, second-degree esophageal varices in 18 patients and third-degree esophageal varices in eight patients; no esophageal varices could be found in four patients. There was no correlation between the degree of the esophageal varices and serum levels of albumin (p-0.7) and SAAG (p-0.2); but a weak correlation was found between the degree of the esophageal varices and ascites levels of albumin (p=0.03, r-0.30). Furthermore, the patients were classified by their SAAG values, and their varices were then assessed. Two of four patients with SAAG values between 1.1 and 1.49 had esophageal varices, as did 13 of 15 patients with »SAAG values between 1.5 and 1.99, and all of the patients with SAAG values greater than 2.0. Conclusion: All SAAG values were greater than 1.1 in our non-alcoholic cirrhosis cases. The correlation that has been found to exist between SAAG and esophageal varices could not be found in our patients with non-alcoholic cirrhosis. It is remarkable that most of the patients with non-alcoholic cirrhosis presenting with ascites and all of the patients with an SAAG value greater than 2.0 had esophageal varices.