• Saira Muhammad Ali Patel Hospital Karachi
  • Syed Zea Ul Islam Farrukh Patel Hospital Karachi
  • Syed Afzal Ul Haq Haqqi Patel Hospital Karachi
  • Arif Rasheed Siddiqui Patel Hospital Karachi
  • Muhammad Zahid Qadri Civil Hospital Karachi
  • Saad Khalid Niaz Patel Hospital Karachi



Background: Infection with hepatitis C virus is reported to have infected almost 71 million people worldwide. This study was done to assess the frequency and associated factors leading to oesophageal varices in patients presenting with hepatitis C related liver cirrhosis. Methods: A cross-sectional study was conducted at Patel Hospital, Karachi, Pakistan from 9th May to 5th October 2019. Patients of either gender having age >20 years presenting with HCV related liver cirrhosis, and Child Pugh class A, B and C were consecutively enrolled in the study. Data on variables like: age, gender, Childs Pugh Score (A/B/C), smoking status, laboratory characteristics like hemoglobulin (Hb), TLC, platelets, serum albumin level, cholesterol, alkaline phosphate (ALK), alkaline transaminase (ALT), ascites and presence of oesophageal varices was recorded and analysed using SPSS-21.0. Results: Out of 167 patients, mean age was 44.86±14.74 years. Eight-nine (53.3%) of the patients were males. The mean duration of cirrhosis was 5.78±1.10 months. Thrombocytopenia was observed in majority (n=130, 77.8%) of the patients. There were 33 (19.8%) patients with Child Pugh score A while Child-Pugh score B and C was found in 67 (40.1%) each. The frequency of oesophageal varices was 141 (84.4%). A significantly higher proportion of oesophageal varices were found among thrombocytopenic patients (p<0.001), ascites (p-0.024), and having “C” Child-Pugh score (p 0.012). Conclusion: Oesophageal varices were found in a considerable proportion. Thrombocytopenia, ascites and Child-Pugh class C were found as leading contributing factors to oesophageal varices.


Gower E, Estes C, Blach S, Shearer KR, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014;61(1):S45–57.

Mohamed AA, Elbedewy TA, El-Serafy M, El-Toukhy N, Ahmed W, Din El Din Z. Hepatitis C virus: a global view. World J Hepatol 2015;7(26):2676–80.

Raja NS, Janjua KA. Epidemiology of hepatitis C virus infection in Pakistan. J Microbiol Immunol Infect 2008;41(1):4–8.

Foster GR, Irving WL, Cheung MC, Walker AJ, Hudson BE, Verma S, et al. Impact of direct acting antiviral therapy in patients with chronic hepatitis C and decompensated cirrhosis. J Hepatol 2016;64(6):1224–31.

Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet 2014;383:1749–61.

Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007;45(5):1290–7.

Merkel C, Zoli M, Siringo S. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenetrol 2000;95(10):2915–20.

Jensen DM. Endoscopic screening for varices in cirrhosis: Findings, implications, and outcomes. Gastroenterology 2002;122(6):1620–30.

Amin M, Jabbar MA, Ahmad H, Samar S. Association between presence of oesophageal varices on endoscopy and extreme degree of f4-stage fibrosis on fibroscan in hcv-related chronic liver disease. Ulutas Med J 2018;4(2):85–9.

Merli M, Nicolini G, Angeloni S, Rinaldi V, De Santis A, Merkel C, et al. Incidence and natural history of small oesophageal varices in cirrhotic patients. J Hepatol 2003;38(3):266–72.

Zein CO, Lindor KD, Angulo P. Prevalence and predictors of oesophageal varices in patients with primary sclerosing cholangitis. Hepatology 2004;39(1):204–10.

Zaman A, Becker T, Lapidus J, Benner K. Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage. Arch Intern Med 2001;161(21):2564–70.

Riggio O, Angeloni S, Nicolini G, Merli M, Merkel C. Endoscopic screening for oesophageal varices in cirrhotic patients. Hepatology 2002;35(2):501–2.

Bressler B, Pinto R, El-Ashry D, Heathcote EJ. Which patients with primary biliary cirrhosis or primary sclerosing cholangitis should undergo endoscopic screening for ooesophageal varices detection? Gut 2005;54(3):407–10.

Sanyal AJ, Fontana RJ, Di Bisceglie AM, Everhart JE, Doherty MC, Everson GT, et al. The prevalence and risk factors associated with oesophageal varices in subjects with hepatitis C and advanced fibrosis. Gastrointest Endosc 2006;64(6):855–64.

Schwarzenberger E, Meyer T, Golla V, Sahdala NP, Min AD. Utilization of platelet count spleen diameter ratio in predicting the presence of oesophageal varices in patients with cirrhosis. J Clin Gastroenterol 2010;44(2):146–50.

Thomopoulos KC, Labropoulou-Karatza C, Mimidis KP, Katsakoulis EC, Iconomou G, Nikolopoulou VN. Non-invasive predictors of the presence of large ooesophageal varices in patients with cirrhosis. Dig Liver Dis 2003;35(7):473–8.

González-Ojeda A, Cervantes-Guevara G, Chávez-Sánchez M, Dávalos-Cobián C, Ornelas-Cázares S, Macías-Amezcua MD, et al. Platelet count/spleen diameter ratio to predict oesophageal varices in Mexican patients with hepatic cirrhosis. World J Gastroenterol 2014;20(8):2079–84.

Ying L, Lin X, Xie ZL, Hu YP, Shi KQ. Performance of platelet count/spleen diameter ratio for diagnosis of oesophageal varices in cirrhosis: a meta-analysis. Dig Dis Sci 2012;57(6):1672–81.

Amin K, Muhammad D, Anjum A, Jamil K, Hassan A. Platelet count to spleen diameter ratio as a predictor of oesophageal varices in patients of liver cirrhosis due to hepatitis C virus. J Univ Med Dent Coll 2012;3(1):6–11.

Sezer OB, Celik D, Tutar N, Özçay F. Can platelet count/spleen diameter ratio be used for cirrhotic children to predict oesophageal varices? World J Hepatol 2016;8(33):1466–70.

Jamil Z, Malik M, Durrani AA. Platelet count to splenic diameter ratio and other noninvasive markers as predictors of oesophageal varices in patients with liver cirrhosis. Turk J Gastroenterol 2017;28(5):347–52.

Colecchia A, Montrone N, Scailoi E, Bacchi-Reggiani ML, Colli A, Casazza G, et al. Measurement of Spleen Stiffness to Evaluate Portal Hypertension and the Presence of Oesophageal Varices in Patients With HCV-Related Cirrhosis. Gastroenterology 2012;143(3):646–4.

Augustin S, Millan M, Gonzalez A, Martell M, Gelabert A, Segarra A, et al. Detection of early portal hypertension with routine data and liver stiffness in patients with asymptomatic liver disease: A prospective study. J Hepatol 2014;60(3):561–9.

Leomine M, Katsahian S, Ziol M, Nahon P, Ganne-Carrie N, Kazemi F, et al. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C or alcohol-related cirrhosis. Aliment Pharmacol Ther 2008;28(9):1102–10.