{"title":"Abnormal gastroesophageal flap valve: A predictor of recurrent variceal hemorrhage","authors":"Jay Chudasama , Shubham Jain , Sanjay Chandnani , Anuraag Jena , Harsh Gandhi , Rishikesh Malokar , Sameet Patel , Saurabh Bansal , Pankaj Nawghare , Vishal sharma , Pravin Rathi , Qais Contractor","doi":"10.1016/j.ajg.2025.01.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and study aims</h3><div>Esophageal variceal bleeding is affected by various risk factors. We hypothesized that increased exposure to gastric acid in patients with abnormal gastroesophageal flap valve (GEFV) might increase esophageal variceal bleeding. The aim of this study is to investigate the relationship between GEFV and esophageal variceal bleeding episodes.</div></div><div><h3>Patients and methods</h3><div>In this cross-sectional study, 300 consecutive patients with esophageal varices and a documented GEFV during esophagogastroduodenoscopy were included. Patients were divided into two groups according to: the Hill’s grade of flap valve (grade 1,2- normal and grade 3,4- abnormal), size of varices − large (>5 mm) and small (<5 mm) and the number of bleeding episodes into: Group A with ≤ 1 and Group B with ≥ 2 bleeding episodes. We compared GEFV and various other factors to the number of variceal bleeding episodes.</div></div><div><h3>Results</h3><div>224 patients (74.60 %) had a normal and 76 (25.40 %) had an abnormal GEFV. Clinical variables were statistically significant in the abnormal GEFV group (P < 0.0.5). Propensity score matching was done to reduce the significant differences in the clinical background at baseline between the 2 groups. 152 patients (76 in each group) were analysed after propensity score matching. A significant difference between the two groups disappeared except for number of bleeding episodes. Binary logistic Cox regression analysis was applied using the clinical variables to assess their role in predicting recurrent variceal bleeding. On univariate analysis, abnormal GEFV and large varices were significantly associated with recurrent esophageal variceal bleed (P = 0.001). On Multivariate analysis, abnormal GEFV (OR 7.25, 95 % CI 3.27– 16.08, P = 0.001), History of EVL (OR 6.21, 95 % CI 1.98– 12.22, P = 0.03) and large varices (OR 5.70, 95 % CI 2.45– 13.20, P = 0.001) were independent predictors for recurrent esophageal variceal bleeding.</div></div><div><h3>Conclusion</h3><div>Abnormal GEFV, History of EVL and large varices are independent risk factors for recurrent esophageal variceal haemorrhage.</div></div>","PeriodicalId":48674,"journal":{"name":"Arab Journal of Gastroenterology","volume":"26 2","pages":"Pages 157-162"},"PeriodicalIF":1.1000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arab Journal of Gastroenterology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1687197925000140","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and study aims
Esophageal variceal bleeding is affected by various risk factors. We hypothesized that increased exposure to gastric acid in patients with abnormal gastroesophageal flap valve (GEFV) might increase esophageal variceal bleeding. The aim of this study is to investigate the relationship between GEFV and esophageal variceal bleeding episodes.
Patients and methods
In this cross-sectional study, 300 consecutive patients with esophageal varices and a documented GEFV during esophagogastroduodenoscopy were included. Patients were divided into two groups according to: the Hill’s grade of flap valve (grade 1,2- normal and grade 3,4- abnormal), size of varices − large (>5 mm) and small (<5 mm) and the number of bleeding episodes into: Group A with ≤ 1 and Group B with ≥ 2 bleeding episodes. We compared GEFV and various other factors to the number of variceal bleeding episodes.
Results
224 patients (74.60 %) had a normal and 76 (25.40 %) had an abnormal GEFV. Clinical variables were statistically significant in the abnormal GEFV group (P < 0.0.5). Propensity score matching was done to reduce the significant differences in the clinical background at baseline between the 2 groups. 152 patients (76 in each group) were analysed after propensity score matching. A significant difference between the two groups disappeared except for number of bleeding episodes. Binary logistic Cox regression analysis was applied using the clinical variables to assess their role in predicting recurrent variceal bleeding. On univariate analysis, abnormal GEFV and large varices were significantly associated with recurrent esophageal variceal bleed (P = 0.001). On Multivariate analysis, abnormal GEFV (OR 7.25, 95 % CI 3.27– 16.08, P = 0.001), History of EVL (OR 6.21, 95 % CI 1.98– 12.22, P = 0.03) and large varices (OR 5.70, 95 % CI 2.45– 13.20, P = 0.001) were independent predictors for recurrent esophageal variceal bleeding.
Conclusion
Abnormal GEFV, History of EVL and large varices are independent risk factors for recurrent esophageal variceal haemorrhage.
期刊介绍:
Arab Journal of Gastroenterology (AJG) publishes different studies related to the digestive system. It aims to be the foremost scientific peer reviewed journal encompassing diverse studies related to the digestive system and its disorders, and serving the Pan-Arab and wider community working on gastrointestinal disorders.