Blood Ammonia as Predictor for Esophageal Varices and Risk of Bleeding

Evaluation of Blood Ammonia Level as a Non Invasive Predictor for Presence of Gastroesophageal Varices and Risk of Bleeding

Assessment of blood ammonia level as a non-invasive predictor for presence of EV and risk of bleeding

A prospective cross sectional study on 150 consecutive patients screening for esophageal varices.

Patient groups groups:

Group (1): 100 patients with esophageal varices

Group (2): 50 chronic liver disease patients with no esophageal varices as a control group.

All patients will be subjected to:

1. - Detailed history-taking

2. - Full clinical examination

3. - Laboratory investigations:

   • Complete blood picture (CBC)
   • Erythrocyte sedimentation rate (ESR)
   • Renal function tests
   • Liver function tests
   • Prothrombin time and activity
   • Viral markers (HCV Ab - HBV Ag)
   • Blood ammonia level.

4. - Pelviabdominal US: Ultrasound examination of the liver, portal venous system, spleen, kidney and other abdominal organs.

5. - Upper GITendoscopy:

   • Varices will be classified according to the Japanese classification 1996,
   • The Baveno 11 score will be used to differentiate between mild and severe portal hypertensive gastropathy.

Inclusion Criteria:

• patients with chronic liver disease

Exclusion Criteria:

• Patient in hepatic encephalopathy or coma.
• Patient in active bleeding or with history of bleeding within the two weeks prior to entry in the study .
• Patients with heart failure.
• Patients with renal failure.
• Patient with hepatocellular carcinoma and portal vein thrombosis.
• Patient taking Beta blockers.