Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy
Background. Portal hypertensive gastropathy (PHG) is a common anomaly with potential for bleeding found in portal hypertension. Blood ammonia levels correlate well with liver disease severity and existence of portosystemic shunts. Increased ammonia results in vasodilation and hepatic stellate cell a...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/9067583 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849411903759056896 |
|---|---|
| author | Ferial El-Kalla Loai Mansour Abdelrahman Kobtan Asmaa Elzeftawy Lobna Abo Ali Sherief Abd-Elsalam Sahar Elyamani Mohamed Yousef I. Amer H. Mourad Mohamed Elhendawy |
| author_facet | Ferial El-Kalla Loai Mansour Abdelrahman Kobtan Asmaa Elzeftawy Lobna Abo Ali Sherief Abd-Elsalam Sahar Elyamani Mohamed Yousef I. Amer H. Mourad Mohamed Elhendawy |
| author_sort | Ferial El-Kalla |
| collection | DOAJ |
| description | Background. Portal hypertensive gastropathy (PHG) is a common anomaly with potential for bleeding found in portal hypertension. Blood ammonia levels correlate well with liver disease severity and existence of portosystemic shunts. Increased ammonia results in vasodilation and hepatic stellate cell activation causing and exacerbating portal hypertension. Objective. To assess the relation of blood ammonia to the presence and severity of portal hypertensive gastropathy in cirrhosis. Methods. This cross-sectional study included 381 cirrhotics undergoing screening for esophageal varices (EV) divided into a portal hypertensive gastropathy group (203 patients with EV and PHG), esophageal varix group (41 patients with EV but no PHG), and control group (137 patients with no EV or PHG). A full clinical examination, routine laboratory tests, abdominal ultrasonography, child score calculation, and blood ammonia measurement were performed for all patients. Results. Blood ammonia, portal vein, splenic vein, and splenic longitudinal diameters were significantly higher and platelet counts lower in patients with EV and EV with PHG than controls. Patients having EV with PHG had significantly higher bilirubin and ammonia than those with EV but no PHG. Severe PHG was associated with significantly higher ammonia, EV grades, and superior location and a lower splenic longitudinal diameter than mild PHG. The PHG score showed a positive correlation with blood ammonia and a negative correlation with splenic longitudinal diameter. Conclusions. Blood ammonia levels correlate with the presence, severity, and score of portal hypertensive gastropathy in cirrhosis suggesting a causal relationship and encouraging trials of ammonia-lowering treatments for the management of severe PHG with a tendency to bleed. |
| format | Article |
| id | doaj-art-597b8c8b3fe741ae87ac4d27ccc3ca2e |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-597b8c8b3fe741ae87ac4d27ccc3ca2e2025-08-20T03:34:37ZengWileyGastroenterology Research and Practice1687-61211687-630X2018-01-01201810.1155/2018/90675839067583Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive GastropathyFerial El-Kalla0Loai Mansour1Abdelrahman Kobtan2Asmaa Elzeftawy3Lobna Abo Ali4Sherief Abd-Elsalam5Sahar Elyamani6Mohamed Yousef7I. Amer8H. Mourad9Mohamed Elhendawy10Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptHepatology and Gastroenterology Department, Faculty of Medicine, Kafrelsheikh University, Kafr Elsheikh, EgyptClinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, EgyptTropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, EgyptBackground. Portal hypertensive gastropathy (PHG) is a common anomaly with potential for bleeding found in portal hypertension. Blood ammonia levels correlate well with liver disease severity and existence of portosystemic shunts. Increased ammonia results in vasodilation and hepatic stellate cell activation causing and exacerbating portal hypertension. Objective. To assess the relation of blood ammonia to the presence and severity of portal hypertensive gastropathy in cirrhosis. Methods. This cross-sectional study included 381 cirrhotics undergoing screening for esophageal varices (EV) divided into a portal hypertensive gastropathy group (203 patients with EV and PHG), esophageal varix group (41 patients with EV but no PHG), and control group (137 patients with no EV or PHG). A full clinical examination, routine laboratory tests, abdominal ultrasonography, child score calculation, and blood ammonia measurement were performed for all patients. Results. Blood ammonia, portal vein, splenic vein, and splenic longitudinal diameters were significantly higher and platelet counts lower in patients with EV and EV with PHG than controls. Patients having EV with PHG had significantly higher bilirubin and ammonia than those with EV but no PHG. Severe PHG was associated with significantly higher ammonia, EV grades, and superior location and a lower splenic longitudinal diameter than mild PHG. The PHG score showed a positive correlation with blood ammonia and a negative correlation with splenic longitudinal diameter. Conclusions. Blood ammonia levels correlate with the presence, severity, and score of portal hypertensive gastropathy in cirrhosis suggesting a causal relationship and encouraging trials of ammonia-lowering treatments for the management of severe PHG with a tendency to bleed.http://dx.doi.org/10.1155/2018/9067583 |
| spellingShingle | Ferial El-Kalla Loai Mansour Abdelrahman Kobtan Asmaa Elzeftawy Lobna Abo Ali Sherief Abd-Elsalam Sahar Elyamani Mohamed Yousef I. Amer H. Mourad Mohamed Elhendawy Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy Gastroenterology Research and Practice |
| title | Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy |
| title_full | Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy |
| title_fullStr | Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy |
| title_full_unstemmed | Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy |
| title_short | Blood Ammonia Level Correlates with Severity of Cirrhotic Portal Hypertensive Gastropathy |
| title_sort | blood ammonia level correlates with severity of cirrhotic portal hypertensive gastropathy |
| url | http://dx.doi.org/10.1155/2018/9067583 |
| work_keys_str_mv | AT ferialelkalla bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT loaimansour bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT abdelrahmankobtan bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT asmaaelzeftawy bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT lobnaaboali bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT sheriefabdelsalam bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT saharelyamani bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT mohamedyousef bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT iamer bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT hmourad bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy AT mohamedelhendawy bloodammonialevelcorrelateswithseverityofcirrhoticportalhypertensivegastropathy |