História natural das varizes esofagicas em crianças e adolescentes

Abstract

Upper gastrointestinal bleeding is considered a condition of high morbidity and mortality in children with portal hypertension (PH) and esophageal varices the main site of bleeding in patients with PH . Endoscopy is now considered the gold standard for the detection of esophageal varices . The factors currently known as predictors of bleeding, mainly from studies in adult patients, the presence of varices grade II and III, red spots on the varices, Child-Pugh score greater than 7, cirrhosis of alcoholic origin and increased portal pressure gradient for values > 12 mmHg . As varices influences the risk of bleeding, knowledge of rates and factors of progression of varices is also necessary. Predictive factors for progression of varices are still unclear, but some authors show that the presence of Child-Pugh B or C, red spots on the existing small-caliber varices and cirrhosis of alcoholic origin are factors that accelerate the progression of esophageal varices. Studies in pediatric patients are scarce and needed for optimal management of patients with portal hypertension in this age group. Thus, understanding and determining the risk factors for onset and progression of EV bleeding and better understanding the natural history of PH, new protocols can be realized, and greater benefits for patients with HP achieved.