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Research Supports Bleeding Prophylaxis in Biliary Atresia

Esophageal varices, gastric varices along cardia may justify prophylaxis in pediatric patients

FRIDAY, Dec. 17 (HealthDay News) -- Children with biliary atresia are at increased risk of portal hypertension early in life, and primary prophylaxis of bleeding is important in those with esophageal varices and red markings and/or gastric varices along the cardia, according to a report published in the December issue of Gastroenterology.

Mathieu Duché, M.D., from the Centre de Référence National de l'Atrésie des Voies Biliaires in Le Kremlin-Bicêtre, France, and colleagues studied 139 children with biliary atresia to determine the risk of gastrointestinal (GI) bleeding associated with endoscopic patterns of varices and portal hypertension. Upper GI endoscopy was performed on 125 children with portal hypertension signs. Sixty-four children underwent a second endoscopy exam after a mean of 51 months.

The researchers found that, at the first endoscopy exam, 88 children had esophageal varices, 74 of whom were younger than 2 years of age. Grade II and III varices were found in 29 children, red markings in 30, gastric varices in 24, and gastropathy signs in 27. GI bleeding occurred in 28 patients. The presence of gastric varices along the cardia was the strongest independent endoscopic sign associated with bleeding risk. The authors concluded that children who have esophageal varices and red markings and/or gastric varices along the cardia should undergo primary prophylaxis of bleeding.

"Fifteen percent of children with biliary atresia present with GI bleeding before the age of 2½ years. The risk of such bleeding can be foreseen by the presence of grade III varices, esophageal red markings, and, above all, the presence of gastric varices along the cardia. Primary prophylaxis of bleeding is justified when these signs are present," the authors write.

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