Correlation between the ratio of portal vein and splenic vein diameter versus grading of esophageal varices and grading of portal hypertensive gastropathy in 50 patients of chronic liver disease

Background: Patients with chronic liver disease need to undergo screening with an upper Gl endoscopy to detect esophageal varices and to institute prophylactic measures in patients with large esophageal varices at the time of diagnosis and during follow up. This poses social and medical burden due to the greater number of cirrhotic patients and lesser number of endoscopic units. In this study we aim to identify the non invasive predictors of esophageal varices particularly portal vein, splenic vein diameter and portal vein/splenic vein diameter ratio. Objective: Assessment of the correlation between the ratio of portal vein and splenic vein diameter with the grading of esophageal varices and portal hypertensive gastropathy in a group of 50 patients diagnosed with chronic liver disease. Materials and methods: Observational study of 50 patients of chronic liver disease were included between June 2022 and November 2022. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup. upper GI endoscopy for Grading of varices and portal hypertensive gastropathy and ultrasonographic measurement of portal vein diameter and splenic vein diameter. Portal vein/Splenic vein diameter ratio was calculated for all patients. Results: Among the 50 patients studied males predominated the study with 80%. Out of the study population 96% of the patients had varices. Higher grades of esophageal varices exists with higher PVD and greater PVD/SVD ratio. In our study we observed that those with Grade 1 esophageal varices had mean PVD/SVD ratio of 1.37 ± 0.08, those with Grade 2 varices had 1.45 ± 0.08 and cases with grade 3 varices had mean ratio of 1.55 ± 0.08, p value was <0.05, which is statistically significant. Moreover we observed that those with mild PHG had mean PVD/SVD ratio of 1.45 ± 0.11, those with moderate PHG had 1.47 ± 0.05 and cases with severe PHG had mean ratio of 1.59 ± 0.07, p value was <0.05, which is statistically significant. Conclusion: From our study we conclude that as PVD/SVD ratio increases there is higher chances of esophageal varices and portal hypertensive gastropathy as well hence prediction of esophageal varices by ratio of portal vein Splenic vein diameter via ultrasound reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being noninvasive, portal vein diameter and Splenic vein diameter ratio count is a relatively inexpensive and easily reproducible.