title: Similarities and differences in the clinical features between cardia varices and esophageal varices.
abstract: OBJECTIVE
  Little is known about the clinical features of cardia varices (CV). The aim was to examine the background, bleeding risk, and post-treatment outcomes of CV in patients with portal hypertension.
  
  
  METHODS
  The subjects of this retrospective study were 277 patients (179 males, 98 females, 62.9 ± 11.5 years) with esophageal varices (EV). In patients with CV, there were 65 bleeders, and 95 patients received endoscopic treatment for primary or secondary prophylaxis.
  
  
  RESULTS
  There were 147 patients with CV (53.1%). The higher grade of EV (P < 0.01) and the lower grade of gastric fundal varices (FV) (P = 0.046) were significant factors for the presence of CV. Significant risk factors for bleeding were: the higher grade of EV (P < 0.01), red sign on EV (P < 0.01), lower albumin (P = 0.01), and Child-Pugh B/C (P < 0.01) for EV and red sign on CV (P < 0.01) and use of non-steroidal anti-inflammatory drugs (NSAIDs)/aspirin (P < 0.01) for CV. All CV disappeared by sclerotherapy combined with argon plasma coagulation or band ligation, and 20 patients (21.1%) in EV and 18 patients (18.9%) in CV had recurrences during the median observation period of 19.4 months. There was no significant difference in the cumulative survival rate between non-bleeders, bleeders from EV, and those from CV.
  
  
  CONCLUSIONS
  The CV were closely associated with advanced grade of EV and less-advanced grade of FV. Further, usage of NSAIDs/aspirin and red sign were significantly related to the bleeding from CV, suggesting the need for careful management.
authors.affiliation: Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kondo
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kiyono
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sekimoto
authors.forename: Taro
authors.initials: T
authors.lastname: Shimada
authors.forename: Masanori
authors.initials: M
authors.lastname: Takahashi
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Okugawa
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yoshizumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D002299:Cardia / Q000098:blood supply*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D005748:Gastric Fundus; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D006975:Hypertension, Portal; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015911:Sclerotherapy; D015996:Survival Rate; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications / Q000401:mortality / Q000628:therapy; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin
keywords: aspirin; cardia varices; non-steroidal anti-inflammatory drugs; variceal bleeding