Assessment of Chronic Liver Disease (CLD) Based on Esophageal Varices in Children

Abstract

Background: Chronic Liver Disease (CLD) is a complex and often debilitating condition that affects individuals of all ages, including children. Within pediatric CLD, one critical aspect that demands careful evaluation is the presence and severity of esophageal varices. If left untreated, these enlarged, fragile blood vessels in the esophagus can lead to life-threatening bleeding. The assessment of esophageal varices plays a pivotal role in managing and prognosis of children with CLD. Aim of the Study: The study aims to measure laboratory parameters and calculate serum liver fibrosis scores in CLD children. Methods: This retrospective study analyzed 24 pediatric patients diagnosed with esophageal varices in Chronic Liver Disease (CLD) at the Department of Pediatric Gastroenterology & Nutrition, BSMMU, Dhaka, Bangladesh, over two years from April 2019 to October 2021. Ethical standards were adhered to with informed consent and ethical committee approval. Results: According to the diagnoses, 50% of the patients were identified as having Wilson's disease. Notably, 16.7% of the patients presented with Grade 4 esophageal varices. In terms of laboratory parameters, the median hemoglobin level was 10.2 gm/dl, the total leukocyte count was 6300/mm3, the platelet count had a median of 90000/µL, the bilirubin level had a median of 2.7 gm/dl, ALT had a median of 57 U/L, AST had a median of 134.5 U/L, GGT had a median of 132 U/L, INR had a median of 1.6, albumin had a median of 25 gm/dl, and cholesterol had a median of 105 mg/dl. Lastly, the median liver stiffness was recorded as 13.1 kPa, with an interquartile range (IQR) spanning from 10.3 to 21. Conclusion: This study highlights the importance of early detection and management of esophageal varices in children with CLD, as they are crucial prognostic indicators for underlying liver conditions. By integrating these clinical tools and parameters, healthcare providers can make informed decisions regarding the management and treatment of children with CLD. Early identification of esophageal varices and a comprehensive assessment of the liver's functional status are essential in improving the overall care and outcomes for pediatric patients with chronic liver disease, ensuring timely intervention and support to enhance their quality of life.