Association between esophageal varices severity and psychological distress in cirrhotic patients
DOI:
https://doi.org/10.69863/dim.2025.e690Keywords:
Anxiety, Depression, Liver Cirrhosis, Upper Gastrointestinal Bleeding, Grading Varices.Abstract
BACKGROUND: Patients with liver cirrhosis are highly vulnerable to psychological disorders; however, the implications of these mental health issues on the severity of esophageal varices remain unclear.
OBJECTIVES: This study aimed to investigate the correlation between the grading of esophageal varices and the occurrence of anxiety and depression in cirrhotic patients experiencing upper gastrointestinal bleeding.
METHODS: This study was conducted on inpatients at Dr. Saiful Anwar General Hospital, Malang, who were diagnosed with liver cirrhosis and experienced upper gastrointestinal bleeding over a six-month period using a consecutive sampling method. The grading of esophageal varices from endoscopic data was categorized according to the First Baveno International criteria. Anxiety and depression levels were assessed using the Hospital Anxiety and Depression Scale (HADS). Statistical analysis was performed using the Chi-Square test with a significance level of p-value < 0.05.
RESULTS: Out of 53 respondents, 46 had large-grade esophageal varices and 7 had small-grade varices. Based on HADS scores, 38 respondents exhibited symptoms of anxiety, 10 were within the normal range, and 5 exhibited symptoms of depression. A significant moderate correlation was found between the grading of esophageal varices and the presence of anxiety and depression in cirrhotic patients with upper gastrointestinal bleeding (p = 0.001; r = 0.445).
CONCLUSION: There is a significant correlation between large-grade esophageal varices and the occurrence of anxiety in cirrhotic patients experiencing upper gastrointestinal bleeding.
References
1. Biecker E. Gastrointestinal bleeding in cirrhotic patients with portal hypertension. ISRN Hepatol 2013;2013(1):541836.doi: 10.1155/2013/541836. PMID: 27335828
2. Maruyama H, Yokosuka O. Pathophysiology of portal hypertension and esophageal varices. Int J Hepatol 2012;2012(1):895787.doi: 10.1155/2012/895787. PMID: 22666604
3. Wang Y, Wang M, Liu C, et al. Global burden of liver cirrhosis 1990-2019 and 20 years forecast: results from the global burden of disease study 2019. Ann Med 2024;56(1):2328521.doi: 10.1080/07853890.2024.2328521. PMID: 38727511
4. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008;371(9615):838-851.doi: 10.1016/S0140-6736(08)60383-9. PMID: 18328931
5. Zimbrean PC, Jakab SS. Depression and anxiety management in cirrhosis. Hepatol Commun 2025;9(1):e0600.doi: 10.1097/HC9.0000000000000600. PMID: 39670879
6. Jiao W, Lin J, Deng Y, et al. The immunological perspective of major depressive disorder: unveiling the interactions between central and peripheral immune mechanisms. J Neuroinflammation 2025;22(1):10.doi: 10.1186/s12974-024-03312-3. PMID: 39828676
7. Ishikawa Y, Furuyashiki T. The impact of stress on immune systems and its relevance to mental illness. Neurosci Res 2022;175(1):16-24.doi: 10.1016/j.neures.2021.09.005. PMID: 34606943
8. Alshehri A, Alshehri B, Alghadir O, et al. The prevalence of depressive and anxiety symptoms among first-year and fifth-year medical students during the COVID-19 pandemic: a cross-sectional study. BMC Med Educ 2023;23(1):411.doi: 10.1186/s12909-023-04387-x. PMID: 37277742
9. Peng JK, Hepgul N, Higginson IJ, et al. Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis. Palliat Med 2019;33(1):24-36.doi: 10.1177/0269216318807051. PMID: 30345878
10. Holmes R, Patel A, Desai AP. Psychiatric disorders and their treatment: Impact of outcomes in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2022;20(2):32-37.doi: 10.1002/cld.1204. PMID: 36033426
11. Hernaez R, Kramer JR, Khan A, et al. Depression and anxiety are common among patients with cirrhosis. Clin Gastroenterol Hepatol 2022;20(1):194-203.doi: 10.1016/j.cgh.2020.08.045. PMID: 32835845
12. Olvera-Cruz SI, Cano-Estrada A, Hernandez-Mariano JA, et al. Association between medication adherence and health-related quality of life among type 2 diabetic adults in Mexico. J Family Med Prim Care 2024;13(10):4521-4527.doi: 10.4103/jfmpc.jfmpc_399_24. PMID: 39629420
13. Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes 2003;1(1):29.doi: 10.1186/1477-7525-1-29. PMID: 12914662
14. Cuschieri S. The STROBE guidelines. Saudi J Anaesth 2019;13(Suppl 1):S31-S34.doi: 10.4103/sja.SJA_543_18. PMID: 30930717
15. Goodyear MD, Krleza-Jeric K, Lemmens T. The Declaration of Helsinki. BMJ 2007;335(7621):624-625.doi: 10.1136/bmj.39339.610000.BE. PMID: 17901471
16. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII - Renewing consensus in portal hypertension. J Hepatol 2022;76(4):959-974.doi: 10.1016/j.jhep.2021.12.022. PMID: 35120736
17. Sara JDS, Toya T, Ahmad A, et al. Mental stress and its effects on vascular health. Mayo Clin Proc 2022;97(5):951-990.doi: 10.1016/j.mayocp.2022.02.004. PMID: 35512885
18. Pratim Das P, Medhi S. Role of inflammasomes and cytokines in immune dysfunction of liver cirrhosis. Cytokine 2023;170(1):156347.doi: 10.1016/j.cyto.2023.156347. PMID: 37639845
19. Popko K, Gorska E, Stelmaszczyk-Emmel A, et al. Proinflammatory cytokines Il-6 and TNF-alpha and the development of inflammation in obese subjects. Eur J Med Res 2010;15 Suppl 2(Suppl 2):120-122.doi: 10.1186/2047-783x-15-s2-120. PMID: 21147638
20. Rodriguez-Gonzalez A, Velasco-Durantez V, Martin-Abreu C, et al. Fatigue, emotional distress, and illness uncertainty in patients with metastatic cancer: Results from the prospective neoetic_seom study. Curr Oncol 2022;29(12):9722-9732.doi: 10.3390/curroncol29120763. PMID: 36547177
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Copyright (c) 1970 Syifa Mustika, Alfan Fathoni, Andre Christian Yohannes Sopacua , Liku Vianty
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