Abnormal gastroesophageal flap valve: a predictor of recurrent variceal haemorrhage

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.

AIM-To investigate the relationship between GEFV and esophageal variceal bleeding episodes.

Methods In this cross-sectional, retrospective 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) and large varices (OR 5.70, 95% CI 2.45– 13.20, P=0.001) were independent predictors for recurrent esophageal variceal bleeding. [1] [2]

Conclusions Abnormal GEFV and large varices are independent risk factors for recurrent esophageal variceal haemorrhage.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Koya Y, Shibata M, Watanabe T, Kumei S, Miyagawa K, Oe S. et al. Influence of gastroesophageal flap valve on esophageal variceal bleeding in patients with liver cirrhosis. Digestive Endoscopy 2021; 33 (01) 100-9
• 2 Haq I, Tripathi D.. Recent advances in the management of variceal bleeding. Gastroenterol Rep (Oxf) 2017; 5 (02) 113

Publication History

Article published online:
15 April 2024