Gastroenterologie
a hepatologie

Endoskopické nálezy u dětských kandidátů transplantace jater na podkladě cirhózy

Seyed Mohsen Dehghani¹, Maryam Abbasi², Maryam Ataollahi¹, Masoud Tahani³, Fateme Parooie³, Iraj Shahramian³

+ Pracoviště
¹ Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
² Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children‘s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
³ Pediatric Gastroenterology and Hepatology Research Center, Zabol University of Medical Sciences, Zabol, Iran

Souhrn

Východiska: Cirhóza je koncovým stadiem jaterního selhání, které se může rozvinout z akutního nebo chronického postižení jater. Pacientům hrozí fatální komplikace jako portální hypertenze nebo krvácení z jícnových varixů. Metody: Tato průřezová studie se zaobírala endoskopickými nálezy u dětských cirhotických pacientů (do 18 let) vybraných pro transplantaci jater. Účastníky byly děti přijaté mezi lety 2012 a 2017 do Shiraz Organ Transplantation Center of Nemazee Hospital, Shiraz University of Medical Sciences. Data jsme získali pomocí speciálně připraveného dotazníku. Výsledky: Celkem jsme zkoumali 199 dětí (z nich 49,2 % byli chlapci), které jsme podrobili endoskopii horní části zažívacího traktu. V průměru jim bylo 6,2 ± 4,7 let. Jejich nejčastějším klinickým projevem byl ikterus (58,8 %). Průměrná hodnota Child-Pugh skóre byla u pacientů 8,53 ± 2,34 a PELD/MELD skóre 14,85 ± 14,93. Z celkového počtu 199 pacientů se jícnové varixy prokázaly u 145 (72,8 %), z nichž 39 (19,7 %) dosáhlo stupně 1, 53 (26,8 %) stupně 2, 42 (21,2 %) stupně 3 a 11 (5,6 %) stupně 4 dle závažnosti. Další projevy se objevily u 31,1 % – portální hypertenzní gastropatie (PHG), 15,1 % – erytém žaludeční sliznice, 6,5 % – fundální varixy, 5,5 % – eroze žaludeční sliznice a 2 % – žaludeční vřed. Nebyla pozorována žádná souvislost mezi výskytem jícnových nebo žaludečních vředů a skórem Child-Pugh nebo PELD/MELD, klinickými projevy, laboratorními výsledky nebo jinými probíhajícími onemocněními. Závěr: Nejčastější příčinou jaterní cirhózy u našich pacientů byla biliární atrezie a nejčastějším endoskopickým nálezem u nich byly jícnové varixy.

Klíčová slova

cirhóza jater, biliární atrezie, jícnové varixy, žloutenka, endoskopie

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