Transient Elastography, Fib-4 score, Lok score and Fibrosis index score as Non Invasive Predictors of Oesphageal Varices, its Degree and Risk of Bleeding in Post Hepatitis C Virus Liver Cirrhosis

Abstract

Background: Cirrhosis is the end result of chronicliver damage caused by chronicliverdiseases. Common causes of chronicliverdisease include Hepatitis C infection (long-term infection), Long-term alcohol abuse, Autoimmune inflammation of the liver, Disorders of the drainage system of the liver (the biliary system), such as primary biliary cirrhosis and primary sclerosing cholangitis, Hepatitis B (long-term infection), Medications, Metabolic disorders of iron and copper (hemochromatosis and Wilson's disease), Nonalcoholic Steatohepatitis (NASH). Egypt has the highest prevalence of hepatitis C virus (HCV) worldwide and a high morbidity and mortality from chronic liver disease. HCV is considered the most common aetiology of chronic liver disease in Egypt. Esophageal varices develop as a consequence of portal hypertension in patients with chronic liver disease and are present in approximately 50% of patients with cirrhosis of the liver. Aims: To evaluate prescence of Oesphageal Varices and its degree and risk of bleeding in post HCV liver Cirrhosis using Transient Elastography, Fib-4 score, Lok score and Fibrosis index score as non-invasive procedures in comparison to upper endoscopy findings. Methodology: This study was a cross sectional study that was conducted on 40 patients with post HCV liver cirrhosis to evaluate prescence of Oesphageal varices and its degree and risk of bleeding using Transient Elastography,Fib-4 score, Lok score and Fibrosis index score as non invasive procedures in comparison to upper endoscopy findings.patients were selected from Ain Shams University hospitals in the period from (June 2014) to (December 2015). Results: Those 40 patients were divided into 2 groups: Group 1: 15 patients with liver cirrhosis ( child A). Group 2: 25 Patients with advanced liver cirrhosis(child B,C).18 patients were child B and 7 patients were child C. Conclusion: LSM and LOK score have significant correlation with EV risk of bleeding and can be used as non invasive markers to predict and follow up risky EVs which will need intervention by endoscopy. LSM and LOK score are sensitive and reliable tests in prediction of large and risky EVs. Recommendations: Although Upper gastrointestinal endoscopy is the gold standard for diagnosis of esophageal varices size, grading and risk of bleeding in newly diagnosed patients with liver cirrhosis. LSM and LOK score can be used for prediction and follow up esophageal varices as regards risk of bleeding. We recommend to do upper endoscopy as soon as possible for patients with liver cirrhosis if LSM >46 kpa and Lok score > 0.86 as they mostly have large risky EVs which will need prophylactic intervention before bleeding occur. Keywords: Transient Elastography, Fib-4 score, Lok score and Fibrosis index score, Oesphageal Varices, Hepatitis C Virus, Liver Cirrhosis