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Gastric food retention at endoscopy is associated with severity of liver cirrhosis

查看全文 作　　者：David B [1]Snell;Shirley Cohen-[2]Mekelburg;Russell [3]Weg;Gaurav [4]Ghosh;Adam P [4]Buckholz;Amit [5]Mehta;Xiaoyue [6]Ma;Paul J [6]Christos;Arun B [5]Jesudian 高影响力作者 机构地区：[1]Division of Gastroenterology and Hepatology,New York University,New York,NY 10016,United States;[2]Division of Gastroenterology and Hepatology,University of Michigan,Ann Arbor,MI 48109,United States;[3]Division of Gastroenterology and Hepatology,University of Rochester Medical Center,Rochester,NY 14642,United States;[4]Department of Medicine,NewYork-Presbyterian Hospital/Weill Cornell Medicine,New York,NY 10065,United States;[5]Division of Gastroenterology&Hepatology,Weill Cornell Medicine,New York,NY 10021,United States;[6]Division of Biostatistics and Epidemiology,Department of Healthcare Policy and Research,Weill Cornell Medicine,New York,NY 10065,United States高影响力机构 出　　处：《World Journal of Hepatology》索引2019年第11卷第11期,共10页高影响力期刊 基　　金：Supported by Clinical and Translational Science Center,No.CTSC Grant UL1 TR002384 摘　　要：BACKGROUND Gastrointestinal symptoms are prevalent in patients with cirrhosis.Cirrhotic patients have a known predilection to delayed gastric emptying compared to those without cirrhosis.However,the contributing factors have not been fully elucidated.Retained gastric food on esophagogastroduodenoscopy(EGD)has been used as a surrogate marker for delayed gastric emptying with reasonably high specificity.Therefore,we hypothesize that the frequency of retained gastric food contents at EGD will be higher in a cirrhotic population compared to a control population without liver disease.Additionally,we hypothesize that increased frequency of gastric food contents will be associated with increased severity of cirrhosis.AIM To determine the relative frequency of delayed gastric emptying among cirrhotics as compared to non-cirrhotics and to identify associated factors.METHODSWe performed a retrospective case-control study of cirrhotic subjects whounderwent EGD at an academic medical center between 2000 and 2015. Threehundred sixty-four patients with confirmed cirrhosis, who underwent a total of1044 EGDs for the indication of esophageal variceal screening or surveillance,were identified. During the same period, 519 control patients without liverdisease, who underwent a total of 881 EGDs for the indication of anemia, wereidentified. The presence of retained food on EGD was used as a surrogate fordelayed gastric emptying. The relative frequency of delayed gastric emptyingamong cirrhotics was compared to non-cirrhotics. Characteristics of patients withand without retained food on EGD were compared using univariable andmultivariable logistic regression analysis to identify associated factors.RESULTSOverall, 40 (4.5%) patients had evidence of retained food on EGD. Cirrhotics weremore likely to have retained food on EGD than non-cirrhotics (9.1% vs 1.4%, P <0.001). Characteristics associated with retained food on univariable analysisincluded age less than 60 years (12.6% vs 5.2%, P = 0.015), opioid use (P = 0.004),Child-Pugh class C (24.1% Child-Pugh class C vs 6.4% Child-Pugh class A, P =0.007), and lower platelet count (P = 0.027). On multivariate logistic regressionanalysis, in addition to the presence of cirrhosis (adjusted OR = 5.83;95%CI: 2.32-14.7, P < 0.001), diabetes mellitus (types 1 and 2 combined) (OR = 2.34;95%CI:1.08-5.06, P = 0.031), opioid use (OR = 3.08;95%CI: 1.29-7.34, P = 0.011), andChild-Pugh class C (OR = 4.29;95%CI: 1.43-12.9, P = 0.01) were also associatedwith a higher likelihood of food retention on EGD.CONCLUSIONCirrhotics have a higher frequency of retained food at EGD than non-cirrhotics.Decompensated cirrhosis, defined by Child-Pugh class C, is associated with ahigher likelihood of delayed gastric emptying. 关 键 词：CHILD-PUGH Cirrhosis ENDOSCOPY GASTRIC EMPTYING MOTILITY
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