Utility of histology for the diagnosis of portal hypertensive gastroenteropathy. Concordance between the endoscopic image and gastrointestinal biopsies. Role of the CD34 marker | Gastroenterología y Hepatología (English Edition)

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Concordancia entre la imagen endoscópica y las biopsias gastrointestinales. Papel del marcador CD34" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1190 "Ancho" => 1586 "Tamanyo" => 83394 ] ] "descripcion" => array:1 [ "en" => "Relationship between bilirubin and vessel diameter in the fundus." ] ] ] "textoCompleto" => "IntroductionPortal hypertensive gastropathy (PHG) is a gastric mucosa lesion present in patients with portal hypertension (PH), the prevalence of which ranges from 7% to 98%,<a class="elsevierStyleCrossRefs" href="#bib0120">1–5</a> according to the published case series. In the case of portal hypertensive enteropathy (PHE), there are very few studies in the literature, with a prevalence of 8.4%–68% described in patients with cirrhosis and PHE.<a class="elsevierStyleCrossRefs" href="#bib0145">6–12</a>PHG is diagnosed by endoscopy. The most common location is the gastric fundus, although lesions may appear anywhere in the gastrointestinal tract. Nevertheless, it can be difficult to differentiate PHG from other vascular lesions, such as gastric antral vascular ectasia (GAVE) and gastritis due to Helicobacter pylori (H. pylori), etc. Microscopic studies can therefore be useful. Histologically, PHG is characterised by dilation and ectasia of the capillaries and venules of the gastric mucosa and submucosa, as well as oedema and thinning of the arteriole and venule wall in the submucosa, with no evidence of inflammation, underlying erosion or fibrin thrombi<a class="elsevierStyleCrossRefs" href="#bib0180">13–15</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In the context of differential diagnosis, there may be significant difficulties when trying to differentiate PHG from GAVE during both endoscopic and histological studies. Histologically, GAVE is characterised by vascular dilation or ectasia, fibrin thrombi, fibromuscular hyperplasia of the lamina propria, fusiform cell proliferation and fibrohyalinosis, with no underlying inflammatory signs. It has also been suggested that the CD34 vascular marker might prove useful for the histological diagnosis of PHG, although the data are contentious.<a class="elsevierStyleCrossRefs" href="#bib0195">16,17</a>The objective of our study was to verify the potential correlation between endoscopic and histological findings suggestive of gastroenteropathy and to assess the utility of measuring the vascular diameter using immunohistochemical staining for CD34 in the histological diagnosis of PHG.Material and methodsParticipantsAll cirrhotic patients in whom an upper gastrointestinal endoscopy was indicated were selected. The patients were recruited from Outpatient Clinics held at the Hepatology Day Hospital or the Gastrointestinal Department's Inpatient Unit at our institute.The patients had to fulfil all the inclusion criteria and none of the exclusion criteria.The inclusion criteria were as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Aged 18 years or older.</li><li class="elsevierStyleListItem" id="lsti0010">•Presence of liver cirrhosis diagnosed by anatomical pathology, clinical or analytical criteria, irrespective of aetiology.</li><li class="elsevierStyleListItem" id="lsti0015">•Wanting to participate and signing the informed consent form after receiving an explanation of the study objectives and procedures.</li></ul>The following were considered exclusion criteria:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">•Patients with contraindications for undergoing a gastrointestinal endoscopy.</li><li class="elsevierStyleListItem" id="lsti0025">•Patient's refusal to undergo an endoscopy.</li><li class="elsevierStyleListItem" id="lsti0030">•Patients with active upper gastrointestinal bleeding (UGIB).</li><li class="elsevierStyleListItem" id="lsti0035">•Presence of concomitant diseases with a life expectancy of less than one year (BCLC stage 3–4 hepatocellular carcinoma, other active neoplasms, etc.).</li></ul>Data collection began in May 2009 and ended in April 2013. Control patients were selected from the Anatomical Pathology Department, where we identified normal gastric biopsies from patients with no liver cirrhosis, according to their medical records.Data collection was done prospectively for patients and retrospectively for controls.Endoscopic procedureAll the enrolled patients underwent an enteroscopy under sedo-analgesia. Enteroscopy was performed with the paediatric colonoscope (Olympus EVIS EXERA II PCF-Q180AL) in order to explore the entire duodenum and proximal jejunum. All of the enteroscopic interventions were performed by the same endoscopist. During endoscopy, the presence and degree of PHG was assessed in the fundus and antrum, as well as the presence and degree of lesions in the duodenum and jejunum. The degree of PHG was assessed and measured using the Tanoue classification.<a class="elsevierStyleCrossRef" href="#bib0205">18</a>Biopsy collectionDuring the procedure, biopsies were taken for anatomical pathology study using standard biopsy forceps. In total, two jejunum biopsies were taken, as well as two duodenum biopsies, two antrum biopsies and two fundus biopsies. These were preserved in formalin until they were sent to the Anatomical Pathology laboratory.The endoscopic biopsies were stained with haematoxylin and eosin. The immunohistochemical study for CD34 class II was performed in an automated manner with the Dako Autostainer Link 48 automated immunohistochemistry processor.Histologically, the presence or absence of biopsy findings suggestive of PHG or GAVE was assessed (capillary congestion, extravasation, oedema, inflammatory changes, fibrin thrombi, fibromuscular hyperplasia of the lamina propria, fusiform cell proliferation, fibrohyalinosis, etc.). In each of the biopsies we assessed the presence or absence of PHG-compatible changes, such as the presence and intensity of ectasia (mild, moderate or severe), vascular congestion, the existence of extravasation and oedema, and the presence or absence of inflammatory changes. In order to differentiate it from GAVE, the existence of fibrin thrombi and fibrohyalinosis was investigated.The immunohistochemical marker CD34 was used in fundus samples in order to identify the presence of blood vessels. Once identified, three different areas were selected and the smallest diameter of the five largest vessels stained with CD34 was measured.The presence or absence of H. pylori and other lesions was also assessed. All biopsies were reviewed by the same pathologist. Said pathologist also reviewed each histological study without knowing the endoscopic diagnosis.Ethical considerations of the studyThe study was submitted and approved by our institute's Ethics Committee. All patients were informed by the principal investigator and signed an informed consent form to participate in the study. In the case of negative controls, anonymous samples were collected.Statistical methodsSample size: In order to estimate the prevalence of gastrointestinal vascular lesions with a 10% accuracy, assuming a confidence interval of 95% and an expected proportion of 50%, it was necessary to enrol 98 patients in the study. The number of controls was determined empirically.Descriptive analysis: For qualitative variables, absolute and relative frequencies were calculated. For quantitative variables, the mean, standard deviation (SD) and minimum and maximum values were calculated.Univariate analysis: For qualitative variables a homogeneity test adapted for discrete distributions was used (chi-squared test, Fisher's exact test or likelihood ratio) based on compliance with the criteria for application. For quantitative variables, we firstly analysed the conditions for applying the different tests (Shapiro–Wilk normality test and Levene's test for equality of variances). The linear or adapted non-parametric model was applied based on compliance with the criteria for application (variance analysis or Mann–Whitney–Wilcoxon test).For modelling, multivariate linear regression models were adapted for each of the response variables. All variables with a p-value below 0.05 in the baseline homogeneity analysis were considered covariables. Repeated measures were taken into account (three measures per individual). The final model was obtained using backward variable selection, considering a significance level of 0.05.ResultsParticipantsA total of 100 cirrhotic patients were enrolled, from whom adequate images and biopsies were obtained to conduct the study. An additional 20 patients with normal gastric biopsies were enrolled as controls.The most important demographic, clinical and analytical data of the patients and controls are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Given that the endoscopic diagnosis of antral PHG and enteropathy was very low (10% and 4% of patients, respectively), it was not possible to make histological and endoscopic comparisons in these locations. Histological analysis was not performed in one patient because the sample obtained was insufficient for diagnosis. For this reason, the total number of patients analysed is 99.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>All of the patients (including controls) tested positive for the CD34 marker, so vascular diameters were successfully measured.Main results(a) A concordance study was performed to assess the presence or absence of PHG in the fundus histology result and endoscopic image. The correlation between the endoscopic and histological diagnosis of PHG was very low, obtaining a kappa coefficient of 0.15 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). It should be highlighted that, while 68% of the patients had an endoscopic image compatible with fundal PHG, only 31% had a histological lesion compatible with PHG (29% mild and 2% moderate). Only 5% of patients with an endoscopy reported as normal presented PHG-compatible histological changes.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>(b) The degree of concordance between the severity of fundal PHG observed endoscopically and histologically was assessed (mild, moderate or severe), obtaining a kappa coefficient of 0.12 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). No statistically significant differences were observed between the mean diameter of the five largest vessels, in three different areas of the fundus, between the patients and controls (p=0.26). The patients presented a mean of 0.0118mm±0.0054 (0.0032–0.0524) and the controls 0.0124mm±0.0055 (0.0057–0.0425). It was assessed whether or not there were statistically significant differences in the fundal vessel diameter of patients with and without PHG (assessed by means of a conventional histological study). The patients with PHG presented a significantly higher mean vessel diameter (p<0.001), with mean values of 0.0101mm±0.0035 (0.0032–0.0194), while the patients without PHG had mean values of 0.0125mm±0.0059 (0.0046–0.0524) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). No differences were observed when we compared the vessel diameters of patients with mild PHG to those with moderate or severe PHG (p=0.44). The patients with mild PHG had a mean of 0.0123mm±0.0058 (0.0046–0.0524) and those with moderate or severe PHG had a mean of 0.0129mm±0.0061 (0.0056–0.0418).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>(c) It was assessed whether the vessel diameter was related to any of the patients’ characteristics, particularly the presence of anaemia. To do so, a univariate analysis was performed which included the group (control, PHG, no PHG), age, gender and analytical parameters (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>In the multivariate analysis the group, platelets, bilirubin (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and prothrombin time were related to the vessel diameter (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>GAVE was not observed in any patient.DiscussionIn our study, gastric biopsy histology in patients with cirrhosis had a very low correlation with both the presence of PHG in endoscopy and the endoscopic degree thereof. This result is in line with previous studies.<a class="elsevierStyleCrossRefs" href="#bib0210">19–21</a> One possible explanation for this low correlation could be that biopsies are superficial and do not allow PHG-compatible changes to be seen in the submucosa. It has also been suggested that the lesions may be focal and, as a result, a sampling error is possible. Finally, this lack of correlation may simply reflect the fact that diagnosing PHG endoscopically is not particularly reliable.No differences were observed in vessel size between the patients and controls, as in a study performed by Misra, where the diameter of the mucosal capillary wall was measured in 73 cirrhotic patients and 64 healthy volunteers.<a class="elsevierStyleCrossRef" href="#bib0225">22</a> There were differences, however, between cirrhotic patients who presented PHG in the histological study and those who did not. Moreover, no differences were observed in vessel size according to the severity of PHG assessed using a histological image. Only two other studies have assessed capillary diameter in PHG. Quintero et al.<a class="elsevierStyleCrossRef" href="#bib0210">19</a> assessed gastric antrum biopsies in patients with UGIB due to PHG, observing that the patients presented larger vessel diameters than the controls. In the second study, performed by Khomeriki et al.,<a class="elsevierStyleCrossRef" href="#bib0230">23</a> gastric body and antrum biopsies were assessed. In this case, the patients with PHG presented a smaller vessel diameter than the patients without PHG, which surprised the authors. Conversely, it is logical that patients with a PHG-compatible histology will also have a larger vessel diameter since this is a diagnostic criterion for PHG.Although the use of CD34 staining allowed vessel diameters to be assessed in more detail, this fact does not seem to provide significantly greater diagnostic reliability with regard to conventional staining techniques.Finally, a modest positive correlation is observed between vessel diameter and bilirubin levels. No previous studies have analysed this finding, but it may well be coherent, since the presence of PHG is correlated with the degree of liver failure.The limitations found in this study are, on the one hand, that no macrobiopsies were performed. The studies published on macrobiopsy are very old, with a limited number of patients, and have not been subsequently validated. Therefore, although they may show the technique to be safe, it does not form part of routine clinical practice and, in our case, due to the high number of biopsies performed, it was not considered ethical to perform a macrobiopsy given that the patient group in question had a greater baseline risk of bleeding due to their cirrhosis. Another limitation was that changes suggestive of PHG present in the submucosa might not have been detected due to the biopsies being superficial. Moreover, only two fundus biopsies were taken, so there is a certain risk that localised lesions may have been overlooked.Another limitation is the low number of patients with liver disease and moderate or severe gastropathy. In the study by Quintero<a class="elsevierStyleCrossRef" href="#bib0210">19</a> the patients with PHG were enrolled after presenting with UGIB due to PHG, so a greater prevalence of advanced liver disease and moderate or severe PHG lesions was to be expected. In our case, the prevalence of PHG in the sample of stable patients who underwent endoscopy was lower than expected. This suggests that PHG is now less common and probably arises in very advanced stages of liver disease progression.Lastly, an additional limitation is that there is no gold standard diagnostic test, since in endoscopic imaging it may be confused with other pathologies and its severity under- or overestimated, and we have already seen how histology is also non-specific. Given these limitations, in our opinion, the diagnosis of gastropathy should be reserved for patients with compatible symptoms (anaemia) who present signs of moderate or severe gastropathy during endoscopy. It would be interesting to determine histological findings in this specific patient group.In conclusion, there is a low correlation between histology and endoscopy for the diagnosis of PHG. Only bilirubin levels present a very modest positive correlation with vessel diameter. The use of CD34 staining does not appear to improve the diagnostic utility of histology.Authors/contributorsThe authors Maria Rosa Bella and Meritxell Casas contributed equally to the preparation of this manuscript.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1164408" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1089779" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1164407" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1089780" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Endoscopic procedure" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Biopsy collection" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical considerations of the study" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical methods" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Main results" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Authors/contributors" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-05-29" "fechaAceptado" => "2018-09-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1089779" "palabras" => array:6 [ 0 => "Gastropathy" 1 => "Concordance" 2 => "Histology" 3 => "Biopsies" 4 => "Immunohistochemistry" 5 => "CD34" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1089780" "palabras" => array:6 [ 0 => "Gastropatía" 1 => "Concordancia" 2 => "Histología" 3 => "Biopsias" 4 => "Inmunohistoquímica" 5 => "CD34" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionUpper gastroscopy in patients with cirrhosis often reveals non-specific lesions, which are usually oriented as portal hypertensive gastropathy (PHG). However, the diagnosis of PHG can be difficult, both from an endoscopic and histological point of view. The study of CD34 expression, which enhances the endothelial cells of the microvasculature, could help the differential diagnosis. The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG. Material and methodsThe results of immunostaining with CD34 gastric fundus biopsies from 100 cirrhotic patients and 20 controls were compared with the endoscopic images. ResultsThe correlation between the histology and the endoscopic diagnosis of PHG was very low (kappa=0.15). In addition, the measurement of the diameter of the gastric vessels enhanced by the use of immunohistochemical staining (CD34) did not show good correlation with the endoscopic diagnosis (p=0.26) and did not provide relevant information for the histological diagnosis of PHG either. DiscussionThe correlation between histology and endoscopy is low for the diagnosis of PHG. The use of immunostaining for CD34 does not seem to improve the diagnostic yield of the histological study." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEn la endoscopia digestiva alta de pacientes con cirrosis hepática a menudo se observan lesiones inespecíficas, que se suelen orientar como gastropatía por hipertensión portal (GHP). Sin embargo, el diagnóstico de GHP puede ser difícil, tanto endoscópica como histológicamente. El estudio de expresión de CD34, que realza las células endoteliales de la microvasculatura podría ayudar al diagnóstico diferencial. Los objetivos del estudio fueron evaluar la correlación entre la endoscopia y la histología en el diagnóstico de la GHP y valorar la utilidad del CD34 en el diagnóstico de la misma. Material y métodosSe analizaron biopsias fúndicas de 100 pacientes cirróticos y 20 controles, y se realizó inmunotinción para CD34. Se compararon con las imágenes endoscópicas. ResultadosSe observó una correlación muy baja entre la histología con el diagnóstico endoscópico de GHP (kappa=0,15). Además, la medición del diámetro de los vasos gástricos realzados mediante el uso de la tinción inmunohistoquímica (CD34) no mostró buena correlación con el diagnóstico endoscópico (p=0,26) y tampoco parece aportar información relevante para el diagnóstico histológico de GHP. DiscusiónExiste una baja correlación entre la histología y la endoscopia para el diagnóstico de GHP. El uso de la inmunotinción para CD34 no mejora la rentabilidad diagnóstica del estudio histológico." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Bella MR, Casas M, Vergara M, Brullet E, Junquera F, Martínez-Bauer E, et al. Utilidad de la histología para el diagnóstico de la gastroenteropatía por hipertensión portal. Concordancia entre la imagen endoscópica y las biopsias gastrointestinales. Papel del marcador CD34. Gastroenterol Hepatol. 2019;42:150–156." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1882 "Ancho" => 2500 "Tamanyo" => 774878 ] ] "descripcion" => array:1 [ "en" => "Histological image of PHG. Staining performed with haematoxylin and eosin. (A and B) The arrows indicate: congestive and dilated capillaries at 200× magnification. (C and D) The arrows indicate: congestive and dilated capillaries at 400× magnification." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1168 "Ancho" => 1584 "Tamanyo" => 57089 ] ] "descripcion" => array:1 [ "en" => "Relationship between vessel diameter and fundus histology." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1190 "Ancho" => 1586 "Tamanyo" => 83394 ] ] "descripcion" => array:1 [ "en" => "Relationship between bilirubin and vessel diameter in the fundus." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HCV: hepatitis C virus; PH: portal hypertension; PHG: portal hypertensive gastropathy; SD: standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients, n=100 (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls, n=20 (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (mean±SD, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.5±12.07, 42–86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.2±15.5, 18–90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender (male/female) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 (72)/28 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (45)/11 (55) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (27.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (22.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Treatments:</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Proton pump inhibitor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Diuretics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Glucose-lowering drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Antihypertensive drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Beta-blockers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="4" align="left" valign="top">Aetiology</td><td class="td" title="table-entry " align="left" valign="top">Alcohol: 57 (57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HCV: 23 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol and HCV: 10 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other: 10 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Child</td><td class="td" title="table-entry " align="left" valign="top">A: 64 (64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">B: 28 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C: 8 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MELD (range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.2 (6.4–22.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Signs of PH (varices or ascites) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">84 (84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">History of bleeding</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Due to varices \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">-Due to PHG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 (43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Iron-deficiency anaemia (ferritin<15ng/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(55.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(20%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemoglobin (g/dl, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.4±2.6, 66–179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.6±1.77, 94–177 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ferritin (ng/ml, range) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">252.8±354.8, 9–1986 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.13±36.68, 18.7–123.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987541.png" ] ] ] ] "descripcion" => array:1 [ "en" => "General characteristics of the patients and controls." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PHG: portal hypertensive gastropathy.The values in bold indicate the boxes in which concordance between the presence or absence of PHG was observed." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Presence of PHG on endoscopy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Presence of PHG in fundus histology</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">No</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">25.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Yes</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">43.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Total</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">68.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987544.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Concordance between the presence or absence of PHG in the fundus histology and endoscopic image." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PHG: portal hypertensive gastropathy.The values in bold indicate the boxes in which there was concordance between the severity observed by means of endoscopy and histology." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Degree of PHG in endoscopy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Degree of PHG in fundus histology</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mild \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Moderate \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">No</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">26.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Mild</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">29.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Moderate</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Total</td><td class="td" title="table-entry " align="char" valign="top">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">68.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987543.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Concordance between the severity observed in the endoscopic image and fundus histology." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "PHG: portal hypertensive gastropathy." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate analysis</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Correlation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Correlation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard error \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Group (control; PHG, no PHG) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets (log) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leukocytes (log) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.0009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bilirubin (log) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0025 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ferritin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.0000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.76 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prothrombin time (log) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.0000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0024 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.0054 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1987542.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Univariate and multivariate analysis results. 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Original article

Utility of histology for the diagnosis of portal hypertensive gastroenteropathy. Concordance between the endoscopic image and gastrointestinal biopsies. Role of the CD34 marker

Utilidad de la histología para el diagnóstico de la gastroenteropatía por hipertensión portal. Concordancia entre la imagen endoscópica y las biopsias gastrointestinales. Papel del marcador CD34

María Rosa Bellaa, Meritxell Casasb, Mercedes Vergarab,c,

Corresponding author

mvergara@tauli.cat

Corresponding author.

, Enric Brulletb,c, Félix Junquerab,c, Eva Martínez-Bauerb, Mireia Miquelb,c, Jordi Sánchez-Delgadob,c, Blai Dalmaub, Rafael Campob,c, Xavier Calvetb,c

a Servicio de Anatomía Patológica, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain

b Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain

c Centro de Investigación biomédica y en Red Enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Portal hypertensive gastropathy &#40;PHG&#41; is a gastric mucosa lesion present in patients with portal hypertension &#40;PH&#41;&#44; the prevalence of which ranges from 7&#37; to 98&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1&#8211;5</span></a> according to the published case series&#46; In the case of portal hypertensive enteropathy &#40;PHE&#41;&#44; there are very few studies in the literature&#44; with a prevalence of 8&#46;4&#37;&#8211;68&#37; described in patients with cirrhosis and PHE&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6&#8211;12</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">PHG is diagnosed by endoscopy&#46; The most common location is the gastric fundus&#44; although lesions may appear anywhere in the gastrointestinal tract&#46; Nevertheless&#44; it can be difficult to differentiate PHG from other vascular lesions&#44; such as gastric antral vascular ectasia &#40;GAVE&#41; and gastritis due to <span class="elsevierStyleItalic">Helicobacter pylori</span> &#40;<span class="elsevierStyleItalic">H&#46; pylori</span>&#41;&#44; etc&#46; Microscopic studies can therefore be useful&#46; Histologically&#44; PHG is characterised by dilation and ectasia of the capillaries and venules of the gastric mucosa and submucosa&#44; as well as oedema and thinning of the arteriole and venule wall in the submucosa&#44; with no evidence of inflammation&#44; underlying erosion or fibrin thrombi<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">13&#8211;15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In the context of differential diagnosis&#44; there may be significant difficulties when trying to differentiate PHG from GAVE during both endoscopic and histological studies&#46; Histologically&#44; GAVE is characterised by vascular dilation or ectasia&#44; fibrin thrombi&#44; fibromuscular hyperplasia of the lamina propria&#44; fusiform cell proliferation and fibrohyalinosis&#44; with no underlying inflammatory signs&#46; It has also been suggested that the CD34 vascular marker might prove useful for the histological diagnosis of PHG&#44; although the data are contentious&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of our study was to verify the potential correlation between endoscopic and histological findings suggestive of gastroenteropathy and to assess the utility of measuring the vascular diameter using immunohistochemical staining for CD34 in the histological diagnosis of PHG&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0025" class="elsevierStylePara elsevierViewall">All cirrhotic patients in whom an upper gastrointestinal endoscopy was indicated were selected&#46; The patients were recruited from Outpatient Clinics held at the Hepatology Day Hospital or the Gastrointestinal Department&#39;s Inpatient Unit at our institute&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patients had to fulfil all the inclusion criteria and none of the exclusion criteria&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The inclusion criteria were as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Aged 18 years or older&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Presence of liver cirrhosis diagnosed by anatomical pathology&#44; clinical or analytical criteria&#44; irrespective of aetiology&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Wanting to participate and signing the informed consent form after receiving an explanation of the study objectives and procedures&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">The following were considered exclusion criteria&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients with contraindications for undergoing a gastrointestinal endoscopy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Patient&#39;s refusal to undergo an endoscopy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Patients with active upper gastrointestinal bleeding &#40;UGIB&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Presence of concomitant diseases with a life expectancy of less than one year &#40;BCLC stage 3&#8211;4 hepatocellular carcinoma&#44; other active neoplasms&#44; etc&#46;&#41;&#46;</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">Data collection began in May 2009 and ended in April 2013&#46; Control patients were selected from the Anatomical Pathology Department&#44; where we identified normal gastric biopsies from patients with no liver cirrhosis&#44; according to their medical records&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Data collection was done prospectively for patients and retrospectively for controls&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Endoscopic procedure</span><p id="par0090" class="elsevierStylePara elsevierViewall">All the enrolled patients underwent an enteroscopy under sedo-analgesia&#46; Enteroscopy was performed with the paediatric colonoscope &#40;Olympus EVIS EXERA II PCF-Q180AL&#41; in order to explore the entire duodenum and proximal jejunum&#46; All of the enteroscopic interventions were performed by the same endoscopist&#46; During endoscopy&#44; the presence and degree of PHG was assessed in the fundus and antrum&#44; as well as the presence and degree of lesions in the duodenum and jejunum&#46; The degree of PHG was assessed and measured using the Tanoue classification&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Biopsy collection</span><p id="par0095" class="elsevierStylePara elsevierViewall">During the procedure&#44; biopsies were taken for anatomical pathology study using standard biopsy forceps&#46; In total&#44; two jejunum biopsies were taken&#44; as well as two duodenum biopsies&#44; two antrum biopsies and two fundus biopsies&#46; These were preserved in formalin until they were sent to the Anatomical Pathology laboratory&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The endoscopic biopsies were stained with haematoxylin and eosin&#46; The immunohistochemical study for CD34 class II was performed in an automated manner with the Dako Autostainer Link 48 automated immunohistochemistry processor&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Histologically&#44; the presence or absence of biopsy findings suggestive of PHG or GAVE was assessed &#40;capillary congestion&#44; extravasation&#44; oedema&#44; inflammatory changes&#44; fibrin thrombi&#44; fibromuscular hyperplasia of the lamina propria&#44; fusiform cell proliferation&#44; fibrohyalinosis&#44; etc&#46;&#41;&#46; In each of the biopsies we assessed the presence or absence of PHG-compatible changes&#44; such as the presence and intensity of ectasia &#40;mild&#44; moderate or severe&#41;&#44; vascular congestion&#44; the existence of extravasation and oedema&#44; and the presence or absence of inflammatory changes&#46; In order to differentiate it from GAVE&#44; the existence of fibrin thrombi and fibrohyalinosis was investigated&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The immunohistochemical marker CD34 was used in fundus samples in order to identify the presence of blood vessels&#46; Once identified&#44; three different areas were selected and the smallest diameter of the five largest vessels stained with CD34 was measured&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The presence or absence of <span class="elsevierStyleItalic">H&#46; pylori</span> and other lesions was also assessed&#46; All biopsies were reviewed by the same pathologist&#46; Said pathologist also reviewed each histological study without knowing the endoscopic diagnosis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical considerations of the study</span><p id="par0120" class="elsevierStylePara elsevierViewall">The study was submitted and approved by our institute&#39;s Ethics Committee&#46; All patients were informed by the principal investigator and signed an informed consent form to participate in the study&#46; In the case of negative controls&#44; anonymous samples were collected&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical methods</span><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sample size&#58;</span> In order to estimate the prevalence of gastrointestinal vascular lesions with a 10&#37; accuracy&#44; assuming a confidence interval of 95&#37; and an expected proportion of 50&#37;&#44; it was necessary to enrol 98 patients in the study&#46; The number of controls was determined empirically&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Descriptive analysis&#58;</span> For qualitative variables&#44; absolute and relative frequencies were calculated&#46; For quantitative variables&#44; the mean&#44; standard deviation &#40;SD&#41; and minimum and maximum values were calculated&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Univariate analysis&#58;</span> For qualitative variables a homogeneity test adapted for discrete distributions was used &#40;chi-squared test&#44; Fisher&#39;s exact test or likelihood ratio&#41; based on compliance with the criteria for application&#46; For quantitative variables&#44; we firstly analysed the conditions for applying the different tests &#40;Shapiro&#8211;Wilk normality test and Levene&#39;s test for equality of variances&#41;&#46; The linear or adapted non-parametric model was applied based on compliance with the criteria for application &#40;variance analysis or Mann&#8211;Whitney&#8211;Wilcoxon test&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">For modelling&#44; multivariate linear regression models were adapted for each of the response variables&#46; All variables with a <span class="elsevierStyleItalic">p</span>-value below 0&#46;05 in the baseline homogeneity analysis were considered covariables&#46; Repeated measures were taken into account &#40;three measures per individual&#41;&#46; The final model was obtained using backward variable selection&#44; considering a significance level of 0&#46;05&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Participants</span><p id="par0145" class="elsevierStylePara elsevierViewall">A total of 100 cirrhotic patients were enrolled&#44; from whom adequate images and biopsies were obtained to conduct the study&#46; An additional 20 patients with normal gastric biopsies were enrolled as controls&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The most important demographic&#44; clinical and analytical data of the patients and controls are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Given that the endoscopic diagnosis of antral PHG and enteropathy was very low &#40;10&#37; and 4&#37; of patients&#44; respectively&#41;&#44; it was not possible to make histological and endoscopic comparisons in these locations&#46; Histological analysis was not performed in one patient because the sample obtained was insufficient for diagnosis&#46; For this reason&#44; the total number of patients analysed is 99&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">All of the patients &#40;including controls&#41; tested positive for the CD34 marker&#44; so vascular diameters were successfully measured&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Main results</span><p id="par0160" class="elsevierStylePara elsevierViewall">&#40;a&#41; A concordance study was performed to assess the presence or absence of PHG in the fundus histology result and endoscopic image&#46; The correlation between the endoscopic and histological diagnosis of PHG was very low&#44; obtaining a kappa coefficient of 0&#46;15 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; It should be highlighted that&#44; while 68&#37; of the patients had an endoscopic image compatible with fundal PHG&#44; only 31&#37; had a histological lesion compatible with PHG &#40;29&#37; mild and 2&#37; moderate&#41;&#46; Only 5&#37; of patients with an endoscopy reported as normal presented PHG-compatible histological changes&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">&#40;b&#41; The degree of concordance between the severity of fundal PHG observed endoscopically and histologically was assessed &#40;mild&#44; moderate or severe&#41;&#44; obtaining a kappa coefficient of 0&#46;12 &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; No statistically significant differences were observed between the mean diameter of the five largest vessels&#44; in three different areas of the fundus&#44; between the patients and controls &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;26&#41;&#46; The patients presented a mean of 0&#46;0118<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;0054 &#40;0&#46;0032&#8211;0&#46;0524&#41; and the controls 0&#46;0124<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;0055 &#40;0&#46;0057&#8211;0&#46;0425&#41;&#46; It was assessed whether or not there were statistically significant differences in the fundal vessel diameter of patients with and without PHG &#40;assessed by means of a conventional histological study&#41;&#46; The patients with PHG presented a significantly higher mean vessel diameter &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; with mean values of 0&#46;0101<span class="elsevierStyleHsp" style=""></span>mm&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;0035 &#40;0&#46;0032&#8211;0&#46;0194&#41;&#44; while the patients without PHG had mean values of 0&#46;0125<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;0059 &#40;0&#46;0046&#8211;0&#46;0524&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; No differences were observed when we compared the vessel diameters of patients with mild PHG to those with moderate or severe PHG &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;44&#41;&#46; The patients with mild PHG had a mean of 0&#46;0123<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;0058 &#40;0&#46;0046&#8211;0&#46;0524&#41; and those with moderate or severe PHG had a mean of 0&#46;0129<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;0061 &#40;0&#46;0056&#8211;0&#46;0418&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">&#40;c&#41; It was assessed whether the vessel diameter was related to any of the patients&#8217; characteristics&#44; particularly the presence of anaemia&#46; To do so&#44; a univariate analysis was performed which included the group &#40;control&#44; PHG&#44; no PHG&#41;&#44; age&#44; gender and analytical parameters &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">In the multivariate analysis the group&#44; platelets&#44; bilirubin &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; and prothrombin time were related to the vessel diameter &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">GAVE was not observed in any patient&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">In our study&#44; gastric biopsy histology in patients with cirrhosis had a very low correlation with both the presence of PHG in endoscopy and the endoscopic degree thereof&#46; This result is in line with previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">19&#8211;21</span></a> One possible explanation for this low correlation could be that biopsies are superficial and do not allow PHG-compatible changes to be seen in the submucosa&#46; It has also been suggested that the lesions may be focal and&#44; as a result&#44; a sampling error is possible&#46; Finally&#44; this lack of correlation may simply reflect the fact that diagnosing PHG endoscopically is not particularly reliable&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">No differences were observed in vessel size between the patients and controls&#44; as in a study performed by Misra&#44; where the diameter of the mucosal capillary wall was measured in 73 cirrhotic patients and 64 healthy volunteers&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> There were differences&#44; however&#44; between cirrhotic patients who presented PHG in the histological study and those who did not&#46; Moreover&#44; no differences were observed in vessel size according to the severity of PHG assessed using a histological image&#46; Only two other studies have assessed capillary diameter in PHG&#46; Quintero et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> assessed gastric antrum biopsies in patients with UGIB due to PHG&#44; observing that the patients presented larger vessel diameters than the controls&#46; In the second study&#44; performed by Khomeriki et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> gastric body and antrum biopsies were assessed&#46; In this case&#44; the patients with PHG presented a smaller vessel diameter than the patients without PHG&#44; which surprised the authors&#46; Conversely&#44; it is logical that patients with a PHG-compatible histology will also have a larger vessel diameter since this is a diagnostic criterion for PHG&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Although the use of CD34 staining allowed vessel diameters to be assessed in more detail&#44; this fact does not seem to provide significantly greater diagnostic reliability with regard to conventional staining techniques&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Finally&#44; a modest positive correlation is observed between vessel diameter and bilirubin levels&#46; No previous studies have analysed this finding&#44; but it may well be coherent&#44; since the presence of PHG is correlated with the degree of liver failure&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The limitations found in this study are&#44; on the one hand&#44; that no macrobiopsies were performed&#46; The studies published on macrobiopsy are very old&#44; with a limited number of patients&#44; and have not been subsequently validated&#46; Therefore&#44; although they may show the technique to be safe&#44; it does not form part of routine clinical practice and&#44; in our case&#44; due to the high number of biopsies performed&#44; it was not considered ethical to perform a macrobiopsy given that the patient group in question had a greater baseline risk of bleeding due to their cirrhosis&#46; Another limitation was that changes suggestive of PHG present in the submucosa might not have been detected due to the biopsies being superficial&#46; Moreover&#44; only two fundus biopsies were taken&#44; so there is a certain risk that localised lesions may have been overlooked&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Another limitation is the low number of patients with liver disease and moderate or severe gastropathy&#46; In the study by Quintero<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a> the patients with PHG were enrolled after presenting with UGIB due to PHG&#44; so a greater prevalence of advanced liver disease and moderate or severe PHG lesions was to be expected&#46; In our case&#44; the prevalence of PHG in the sample of stable patients who underwent endoscopy was lower than expected&#46; This suggests that PHG is now less common and probably arises in very advanced stages of liver disease progression&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Lastly&#44; an additional limitation is that there is no gold standard diagnostic test&#44; since in endoscopic imaging it may be confused with other pathologies and its severity under- or overestimated&#44; and we have already seen how histology is also non-specific&#46; Given these limitations&#44; in our opinion&#44; the diagnosis of gastropathy should be reserved for patients with compatible symptoms &#40;anaemia&#41; who present signs of moderate or severe gastropathy during endoscopy&#46; It would be interesting to determine histological findings in this specific patient group&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">In conclusion&#44; there is a low correlation between histology and endoscopy for the diagnosis of PHG&#46; Only bilirubin levels present a very modest positive correlation with vessel diameter&#46; The use of CD34 staining does not appear to improve the diagnostic utility of histology&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Authors&#47;contributors</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors Maria Rosa Bella and Meritxell Casas contributed equally to the preparation of this manuscript&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Upper gastroscopy in patients with cirrhosis often reveals non-specific lesions&#44; which are usually oriented as portal hypertensive gastropathy &#40;PHG&#41;&#46; However&#44; the diagnosis of PHG can be difficult&#44; both from an endoscopic and histological point of view&#46; The study of CD34 expression&#44; which enhances the endothelial cells of the microvasculature&#44; could help the differential diagnosis&#46; The objectives of this study were to evaluate the correlation between endoscopy and histology in the diagnosis of PHG and to assess the utility of CD34 in the diagnosis of PHG&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The results of immunostaining with CD34 gastric fundus biopsies from 100 cirrhotic patients and 20 controls were compared with the endoscopic images&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The correlation between the histology and the endoscopic diagnosis of PHG was very low &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#41;&#46; In addition&#44; the measurement of the diameter of the gastric vessels enhanced by the use of immunohistochemical staining &#40;CD34&#41; did not show good correlation with the endoscopic diagnosis &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;26&#41; and did not provide relevant information for the histological diagnosis of PHG either&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The correlation between histology and endoscopy is low for the diagnosis of PHG&#46; The use of immunostaining for CD34 does not seem to improve the diagnostic yield of the histological study&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En la endoscopia digestiva alta de pacientes con cirrosis hep&#225;tica a menudo se observan lesiones inespec&#237;ficas&#44; que se suelen orientar como gastropat&#237;a por hipertensi&#243;n portal &#40;GHP&#41;&#46; Sin embargo&#44; el diagn&#243;stico de GHP puede ser dif&#237;cil&#44; tanto endosc&#243;pica como histol&#243;gicamente&#46; El estudio de expresi&#243;n de CD34&#44; que realza las c&#233;lulas endoteliales de la microvasculatura podr&#237;a ayudar al diagn&#243;stico diferencial&#46; Los objetivos del estudio fueron evaluar la correlaci&#243;n entre la endoscopia y la histolog&#237;a en el diagn&#243;stico de la GHP y valorar la utilidad del CD34 en el diagn&#243;stico de la misma&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron biopsias f&#250;ndicas de 100 pacientes cirr&#243;ticos y 20 controles&#44; y se realiz&#243; inmunotinci&#243;n para CD34&#46; Se compararon con las im&#225;genes endosc&#243;picas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; una correlaci&#243;n muy baja entre la histolog&#237;a con el diagn&#243;stico endosc&#243;pico de GHP &#40;kappa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;15&#41;&#46; Adem&#225;s&#44; la medici&#243;n del di&#225;metro de los vasos g&#225;stricos realzados mediante el uso de la tinci&#243;n inmunohistoqu&#237;mica &#40;CD34&#41; no mostr&#243; buena correlaci&#243;n con el diagn&#243;stico endosc&#243;pico &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#41; y tampoco parece aportar informaci&#243;n relevante para el diagn&#243;stico histol&#243;gico de GHP&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Existe una baja correlaci&#243;n entre la histolog&#237;a y la endoscopia para el diagn&#243;stico de GHP&#46; El uso de la inmunotinci&#243;n para CD34 no mejora la rentabilidad diagn&#243;stica del estudio histol&#243;gico&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Bella MR&#44; Casas M&#44; Vergara M&#44; Brullet E&#44; Junquera F&#44; Mart&#237;nez-Bauer E&#44; et al&#46; Utilidad de la histolog&#237;a para el diagn&#243;stico de la gastroenteropat&#237;a por hipertensi&#243;n portal&#46; Concordancia entre la imagen endosc&#243;pica y las biopsias gastrointestinales&#46; Papel del marcador CD34&#46; Gastroenterol Hepatol&#46; 2019&#59;42&#58;150&#8211;156&#46;</p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Histological image of PHG&#46; Staining performed with haematoxylin and eosin&#46; &#40;A and B&#41; The arrows indicate&#58; congestive and dilated capillaries at 200&#215; magnification&#46; &#40;C and D&#41; The arrows indicate&#58; congestive and dilated capillaries at 400&#215; magnification&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HCV&#58; hepatitis C virus&#59; PH&#58; portal hypertension&#59; PHG&#58; portal hypertensive gastropathy&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls&#44; <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;mean</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#44; range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;07&#44; 42&#8211;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">58&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;5&#44; 18&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender &#40;male&#47;female&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;72&#41;&#47;28 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;45&#41;&#47;11 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Hypertension</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;27&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;22&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Kidney failure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Treatments&#58;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Proton pump inhibitor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Diuretics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Glucose-lowering drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Antihypertensive drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Beta-blockers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Aetiology</span></td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&#58; 57 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HCV&#58; 23 &#40;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcohol and HCV&#58; 10 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other&#58; 10 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Child</span></td><td class="td" title="table-entry  " align="left" valign="top">A&#58; 64 &#40;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">B&#58; 28 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C&#58; 8 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">MELD &#40;range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;2 &#40;6&#46;4&#8211;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Signs of PH &#40;varices or ascites&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">84 &#40;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">History of bleeding</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Due to varices&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-Due to PHG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anaemia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Iron-deficiency anaemia &#40;ferritin</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">15</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ng&#47;ml&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;55&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Haemoglobin &#40;g&#47;dl&#44; range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&#44; 66&#8211;179&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;77&#44; 94&#8211;177&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Ferritin &#40;ng&#47;ml&#44; range&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">252&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>354&#46;8&#44; 9&#8211;1986&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&#46;13<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#46;68&#44; 18&#46;7&#8211;123&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">General characteristics of the patients and controls&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">PHG&#58; portal hypertensive gastropathy&#46;</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The values in bold indicate the boxes in which concordance between the presence or absence of PHG was observed&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Presence of PHG on endoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Presence of PHG in fundus histology</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">No</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">25</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">25&#46;25</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Yes</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">26</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">43&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">26&#46;26</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Total</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">68&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Concordance between the presence or absence of PHG in the fundus histology and endoscopic image&#46;</p>"
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      5 => array:8 [
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">PHG&#58; portal hypertensive gastropathy&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The values in bold indicate the boxes in which there was concordance between the severity observed by means of endoscopy and histology&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Degree of PHG in endoscopy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Degree of PHG in fundus histology</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">No</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">26</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">26&#46;3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Mild</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">19</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">29&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">19&#46;2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Moderate</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleBold">0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Total</td><td class="td" title="table-entry  " align="char" valign="top">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">68&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate analysis</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Correlation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard error&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Correlation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Standard error&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Group &#40;control&#59; PHG&#44; no PHG&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets &#40;log&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Leukocytes &#40;log&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;0009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bilirubin &#40;log&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ferritin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prothrombin time &#40;log&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;0054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Univariate and multivariate analysis results&#46; Relationship between blood vessel diameter and different parameters studied&#46;</p>"
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      "titulo" => "References"
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          "identificador" => "bibs0015"
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            0 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural history of portal hypertensive gastropathy in patients with liver cirrhosis&#46; The New Italian Endoscopic Club for the study and treatment of esophageal varices &#40;NIEC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Primignani"
                            1 => "L&#46; Carpinelli"
                            2 => "P&#46; Preatoni"
                            3 => "G&#46; Battaglia"
                            4 => "A&#46; Carta"
                            5 => "A&#46; Prada"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10889167"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;K&#46; Sarin"
                            1 => "D&#46;V&#46; Sreenivas"
                            2 => "D&#46; Lahoti"
                            3 => "A&#46; Saraya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "1992"
                        "volumen" => "102"
                        "paginaInicial" => "994"
                        "paginaFinal" => "999"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                            4 => "M&#46; Menozzi"
                            5 => "C&#46; Span&#242;"
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                    ]
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                    0 => array:1 [
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                        "tituloSerie" => "Gastroenterology"
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Article information

ISSN: 24443824
Original language: English

DOI:10.1016/j.gastre.2019.02.015

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	1	10
2024 October	45	19	64
2024 September	76	13	89
2024 August	51	4	55
2024 July	50	7	57
2024 June	28	3	31
2024 May	34	5	39
2024 April	64	12	76
2024 March	49	6	55
2024 February	58	3	61
2024 January	56	8	64
2023 December	44	3	47
2023 November	70	16	86
2023 October	99	10	109
2023 September	51	5	56
2023 August	43	3	46
2023 July	51	6	57
2023 June	65	3	68
2023 May	74	4	78
2023 April	73	2	75
2023 March	101	12	113
2023 February	57	5	62
2023 January	57	3	60
2022 December	40	5	45
2022 November	62	6	68
2022 October	40	11	51
2022 September	43	10	53
2022 August	41	18	59
2022 July	39	12	51
2022 June	42	15	57
2022 May	63	10	73
2022 April	37	15	52
2022 March	75	9	84
2022 February	58	19	77
2022 January	92	23	115
2021 December	88	12	100
2021 November	35	12	47
2021 October	45	17	62
2021 September	44	7	51
2021 August	137	8	145
2021 July	27	4	31
2021 June	24	11	35
2021 May	33	8	41
2021 April	37	4	41
2021 March	21	4	25

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