Approche non Endoscopique du Diagnostic des Varices Œsophagiennes d’Origine Cirrhotique dans une Population d’Afrique Noire Subsaharienne

JR Moulion Tapouh, O Njoya, C Monabang Zoé, B Moifo, M Kowo, S Nko'o Amvene

Abstract


RÉSUMÉ
OBJECTIFS. Identifier des paramètres cliniques et para cliniques pour l’approche non endoscopique du diagnostic des varices œsophagiennes chez les patients atteints de cirrhose, en contexte sub-saharien.
MATÉRIELS ET MÉTHODES. Les dossiers de patients cirrhotiques camerounais examinés au Centre Hospitalier et Universitaire de Yaoundé entre mars 2013 et novembre 2014 ont été revus. Les données cliniques, biologiques, échographiques et ont été analysées et comparées à la sévérité des varices œsophagiennes retrouvées par endoscopie. La méthode de classification et régression par carte a permis de construire un arbre de prédiction des varices œsophagiennes.
RÉSULTATS. Nous avons inclus 98 patients cirrhotiques d’âge compris entre 14 et 80 ans. Les hépatites virales B et C ont été retrouvées chez 78 patients (79,59%). 53 patients (54,08%) étaient classés Child-Pugh C. La prévalence des varices œsophagiennes était de 92% (90/98) avec 63,27% de grade III. Les variables indépendamment associés à la sévérité des varices œsophagiennes étaient les taux de prothrombine, d’hémoglobine, d’albumine, de leucocytes, de créatinine sérique et la taille de la rate. Ces facteurs ont été utilisés pour construire un arbre de prédiction de survenue des VO.
CONCLUSION. A l’aide d’un arbre décisionnel intégrant la taille de la rate et cinq facteurs biologiques, il est possible de prédire la sévérité des varices œsophagiennes post-cirrhotiques en contexte sub-saharien.
SUMMARY

OBJECTIVES. To identify some clinical and para clinical parameters for non-endoscopic screening of esophageal varices in patients with liver cirrhosis, in sub-Saharan setting.
MATERIALS AND METHODS. The medical records of black African Cameroonian cirrhotic patients received between March 2013 and November 2014 in the University Teaching Hospital of Yaounde were reviewed. Clinical, biological and sonographic findings were analyzed and compared to the severity of endoscopically diagnosed esophageal varices. The classification and regression tree method was used to build a prediction tree of esophageal varices.
RESULTS. We studied 98 cirrhotic patients aged 14-80 years. Viral hepatitis B and C were found in 78 (79.59%) patients. Cirrhosis was graded Child-Pugh C in 53 patients (54.08%). The prevalence of esophageal varices was 92% (90/98) with 63.27% of grade III. The factors independently associated with the severity of esophageal varices were prothrombin time, hemoglobin level, albumin, leukocytes, serum creatinin level and the size of the spleen. We used these factors to build a predictive tree for esophageal varices.
CONCLUSION. A prediction tree including the spleen size and five biological factors could help to predict the severity of post-cirrhotic esophageal varices in sub-Saharan setting without systematic use of endoscopy.


Keywords


arices œsophagiennes-Cirrhose-Afrique sub-saharienne

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