title: The risk factors for bleeding of fundal varices in patients with liver cirrhosis.
abstract: OBJECTIVE
  The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices.
  
  
  METHODS
  In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied.
  
  
  RESULTS
  There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1±7.7 mm Hg vs 19.7±5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3±5.8 mm Hg vs 17.0±8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016).
  
  
  CONCLUSIONS
  Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.
authors: Institution for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Seoul, Korea.
authors: Eui Ju
authors: EJ
authors: Park
authors: Jae Young
authors: JY
authors: Jang
authors: Ji Eun
authors: JE
authors: Lee
authors: Soung Won
authors: SW
authors: Jeong
authors: Sae Hwan
authors: SH
authors: Lee
authors: Sang Gyune
authors: SG
authors: Kim
authors: Sang-Woo
authors: SW
authors: Cha
authors: Young Seok
authors: YS
authors: Kim
authors: Young Deok
authors: YD
authors: Cho
authors: Joo Young
authors: JY
authors: Cho
authors: Hong Soo
authors: HS
authors: Kim
authors: Boo Sung
authors: BS
authors: Kim
authors: Yong Jae
authors: YJ
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000503:physiopathology*; D004947:Esophagus; D005260:Female; D005748:Gastric Fundus; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D012082:Renal Veins; D012307:Risk Factors; D013162:Splenic Vein; D013270:Stomach / Q000098:blood supply*; D016157:Vascular Fistula / Q000150:complications / Q000503:physiopathology*
keywords: Cirrhosis; Fundal varices; Hepatic venous pressure gradient; Hypertension, portal; Portasystemic shunt, surgical