Non-Invasive Evaluation of Esophageal and Fundic Varices in Primary Biliary Cholangitis
Overview
This study assessed the utility of transient elastography (TE) and ultrasound imaging in predicting esophageal and fundic varices in patients with primary biliary cholangitis (PBC). Among 282 patients analyzed, 77% had varices, with older age and lower platelet counts significantly associated with variceal presence. Ultrasound features of portal hypertension were also prevalent and correlated with variceal development.
Background
Primary biliary cholangitis is a chronic cholestatic liver disease often complicated by portal hypertension, which can lead to variceal rupture and hemorrhage with poor survival outcomes. Early detection of varices is critical to prevent gastrointestinal bleeding. While esophagogastroduodenoscopy (EGD) is the gold standard for variceal detection, it is invasive and may be unnecessary in many patients. Non-invasive methods such as transient elastography and ultrasound imaging have been proposed to predict portal hypertension and varices, but their accuracy in PBC requires further evaluation.
Data Highlights
Characteristic
Varices Group (n=217)
Non-Varices Group (n=65)
p-value
Age (years)
60
50
<0.001
Platelet Count (×10⁹/L)
91
196
<0.001
Ultrasound PH Manifestations (%)
30.1%
Not specified
Not specified
Ascites (n)
37
Not specified
Not specified
Recanalized Umbilical Vein (n)
32
Not specified
Not specified
Portosystemic Collaterals (n)
22
Not specified
Not specified
Portal Vein Thrombosis (n)
14
Not specified
Not specified
Key Findings
Esophageal or fundic varices were present in 77% of patients with PBC undergoing EGD.
Patients with varices were significantly older (median 60 vs. 50 years) and had lower platelet counts (median 91 ×10⁹/L vs. 196 ×10⁹/L).
Ultrasound manifestations associated with portal hypertension were observed in 30.1% of patients, including ascites, recanalized umbilical veins, portosystemic collaterals, and portal vein thrombosis.
Transient elastography and ultrasound imaging were investigated as non-invasive predictors of varices, aiming to reduce unnecessary endoscopic screening.
Logistic regression and ROC curve analyses were used to identify independent risk factors and optimal diagnostic thresholds for variceal development and hemorrhage.
Clinical Implications
Non-invasive assessments such as transient elastography and targeted ultrasound imaging can aid in identifying PBC patients at higher risk for esophageal and fundic varices, potentially reducing reliance on invasive endoscopic screening. Monitoring platelet counts and ultrasound features of portal hypertension may help stratify patients for timely intervention to prevent variceal bleeding.
Conclusion
The study supports the use of non-invasive methods including transient elastography and ultrasound imaging to predict varices in PBC patients, highlighting their potential to improve screening efficiency and patient outcomes by identifying those at risk for portal hypertension complications.
References
Baveno VII Consensus Workshop 2022 -- Portal Hypertension Guidelines
UK Guidelines on Management of Variceal Hemorrhage in Cirrhosis 2015
Beijing Youan Hospital PBC Study 2010-2023 -- Non-Invasive Variceal Evaluation
