The Correlation Between Plasma Asymmetric Dimethylarginine (ADMA) Levels and the Presence of Esophageal Varices and Its Grading in Cirrhotic Patients

Background/Aim: Egypt has the highest country wide prevalence of HCV in the world. Uppergastrointestinal bleeding is among leading causes of death in patients with liver cirrhosis and portal hypertension. Asymmetric dimethylarginine (ADMA) is a naturally occurring amino acid that had been known to biochemists for decades. ADMA is an important regulator of vascular function. The present study was designed to evaluate the efficiency of ADMA as a simple non-invasive method easily available in clinical practice in prediction of high risk esophageal varices in cirrhotic patients as first line screening for OV, and to detect the correlation between ADMA and OV grading. Patients and Methods: The study population consisted of 30 patients suffering from Post-hepatitis C virus (HCV) cirrhosis and 10 patients as a normal control group. Patients will be divided into 3 subgroups: Group 1: 10 patients liver cirrhosis without esophageal varices, Group 2: 10 patients with liver cirrhosis with esophageal varices grade I, II and Group 3: 10 patients with liver cirrhosis with esophageal varices grade III, IV. All patients will be subjected to detailed clinical and laboratory evaluation, including ADMA plasma level determination, liver function tests, hepatitis markers, and autoantibodies when needed, in addition to upper abdominal ultrasonography. The controls (10 subjects) had normal liver enzymes and no clinical, laboratory or imaging evidence of liver disease. All cirrhotic patients are subjected to upper endoscopy examination for diagnosis and grading of esophageal varices. Results: In liver cirrhosis without varices, the mean value of ADMA level is 0.58±0.27 μmol/L . In Liver cirrhosis with esophageal varices grade (I/II) the mean value is 0.69±0.37 /μmol/L, in Liver cirrhosis with esophageal varices grade (III/IV) the mean value is 1.45±0.46 μmol/L, and in the control group with a mean value of 0.25±0.07 μmol/L. The elevation in serum ADMA in patients was found to be significant compared to the control group. Conclusion: This study concluded that: In cirrhotic patient, upper GIT endoscopy is still the gold standard in esophageal varices diagnosis, but ADMA level in serum is a non-invasive parameter can predict the presence of the varices and can be used for the purpose of improving yield and cost-effectiveness when electively selecting patients for screening endoscopy and prophylactic therapy to decrease the incidence of first-time variceal bleeding. Increased ADMA are predictors of portal hypertension and (presence grading) of esophageal varices in cirrhotic liver due to virus C.