Background and study aims: Non-invasive predictors of medium/large oesophageal varices (LOVs) could
reduce the number of screening endoscopies. As portal hypertension is a consequence of liver fibrosis,
serum fibrosis markers were evaluated together with other variables as possible non-invasive predictors
of medium OV/LOV.
Patients and methods: A total of 154 cirrhotic patients with splenomegaly and 30 healthy control subjects
were recruited in a prospective study in two gastroenterology centres in Upper Egypt. Clinical parameters
assessed included Child–Pugh class, liver size and ascites. Laboratory parameters included complete
blood count, liver function tests, and aspartate aminotransferase (AST)/platelet ratio. Transforming
growth factor-b1 (TGF-b1), alpha2 macroglobulin (A2M) and hyaluronic acid (HA) were assayed. Ultrasonographic examination was done for assessment of liver span, portal vein diameter and detection of minimal ascites. Oesophageal varices were diagnosed and graded by oesophagogastroduodenoscopy.
Results: Fifty-four patients (35%) had no or small varices and 100 (65%) patients had medium OV/LOV by
endoscopy. On multivariate analysis, the independent predictors of medium OV/LOV were the presence
of ascites (b = 0.258, p = 0.047) and serum HA (b = 0.449, p = 0.009). The receiver operating characteristic
curve for HA showed the area under the curve to be 0.916. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of HA at a cut-off value of 207 lg l1 were 94%, 77.8%,
88.7%, 87.5% and 88.3%, respectively.
Conclusions: The presence of ascites and serum HA level higher than 207 lg l1 can predict the presence
of medium OV/LOV in cirrhotic patients. This would help physicians to identify patients who would most
likely benefit from screening endoscopy and thus, reduce costs and discomfort from unnecessary endoscopic procedures.