The risk factors for bleeding of fundal varices in patients with liver cirrhosis

• Published in: Gut and liver Vol. 7; no. 6; pp. 704 - 711
• Main Authors: Park, Eui Ju, Jang, Jae Young, Lee, Ji Eun, Jeong, Soung Won, Lee, Sae Hwan, Kim, Sang Gyune, Cha, Sang-Woo, Kim, Young Seok, Cho, Young Deok, Cho, Joo Young, Kim, Hong Soo, Kim, Boo Sung, Kim, Yong Jae
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Pancreatobiliary Association; Korean Society of Gastrointestinal Cancer 01.11.2013; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Adult; Aged; cirrhosis; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - physiopathology; Esophagus; Female; fundal varices; Gastric Fundus; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - physiopathology; hepatic venous pressure gradient; Humans; hypertension; Hypertension, Portal - complications; Hypertension, Portal - physiopathology; Liver Cirrhosis - complications; Liver Cirrhosis - physiopathology; Male; Middle Aged; Original; portal; Portal Pressure; portasystemic shunt; Renal Veins; Risk Factors; Splenic Vein; Stomach - blood supply; surgical; Vascular Fistula - complications; Vascular Fistula - physiopathology; 내과학; Fundal varices; Cirrhosis; Hepatic venous pressure gradient; Portasystemic shunt, surgical; Hypertension, portal
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl.2013.7.6.704

The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices. In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied. There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1±7.7 mm Hg vs 19.7±5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3±5.8 mm Hg vs 17.0±8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016). Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.