DOI: 10.36347/sjams.2022.v10i10.026

Pages: 1743-1751

Introduction: Chronic liver disease is an important cause of morbidity and mortality in Bangladeshi children. Development of esophageal varices and bleeding is one of the major complications of CLD. The mortality from each episode of variceal bleeding is 30-50% depending on the clinical status of the patient. The upper GI endoscopy is currently the best reliable method available to diagnose the presence of esophageal varices. Objective: To Assess the correlation between blood ammonia level and grading of esophageal varices in CLD patients. Methods: This cross sectional observational study was conducted at the Department of Paediatric Gastroenterology and Nutrition, BSMMU, Dhaka from January 2018 to December 2019. A total of 63 cases of CLD were selected. Study sample were selected according to the inclusion and exclusion criteria. Along with proper clinical history, examination & initial investigation, fasting venous blood ammonia level and upper GI endoscopy were done in all patients. Receiver-Operator Characteristic (ROC) curve was analysis to set up a cut-off value of blood ammonia for prediction of esophageal varices. Sensivity, specificity, positive predictive value, negative predictive value and accuracy were determined to see the performance of blood ammonia value as a diagnostic test for esophageal varices. Results: Among the 63 patients, (74.6%) had esophageal varices. Wilson disease was the most common etiology of CLD (43; 68.3%) among the studied patients. Among the studied patient, the mean ± SD blood ammonia level was 40.5± 18.0 µmol/L in absent esophageal varices group, 50.5± 14.3 µmol/L in grade I varices group, 50.7± 9.9 µmol/L in grade II esophageal varices group, 53.1± 26.9 µmol/L in grade III varices group and 71.9± 19.0 µmol/L in grade IV esophageal varices group. Here p value is 0.002, which is statistically significant. It was observed that the mean ± SD blood ammonia level was 56.2± 17.9 µmol/L in esophageal varices present group (n = 47) ....