Association between Blood Ammonia Level and Severity of Portal Hypertensive Gastropathy in Egyptian Patients with Post Hepatitis C Virus Cirrhosis | ||
| Ain Shams Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 19 November 2025 PDF (473.12 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asmj.2025.367864.1408 | ||
| Authors | ||
| Marwa Ahmed Mohamed* 1; Moataz Mohamed Sayed2; Eslam Safwat2; Al Sayed Hasan Mohamed Hasan2; Nouran Mohamed Saed2 | ||
| 1Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||
| 2Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. | ||
| Abstract | ||
| Background: Portal hypertensive gastropathy (PHG) is a prevalent consequence of portal hypertension (PHT), impacting between 20–98% of individuals with cirrhosis. Given that PHT arises as a result of liver cirrhosis, serum biomarkers such as blood ammonia levels may serve as non-invasive indicators for the presence and severity of PHG. Aim of the Work: To evaluate the relationship between blood ammonia levels and the severity of PHG in Egyptian cirrhotic patients with hepatitis C virus (HCV) infection. Patients and Methods: This case-control study included 100 HCV-related cirrhotic patients from Ain Shams University Hospital and Kafr-El Sheikh Liver Center. Patients were categorized into four groups based on the presence of esophageal varices (OV) and PHG. Clinical, laboratory, ultrasonographic, and endoscopic evaluations were performed. Serum ammonia levels were measured using EDTA-anticoagulated samples. Results: Blood ammonia levels were significantly elevated in patients with severe PHG (154.9 ± 16.3 μg/dL) compared to mild PHG (110.8 ± 19.5 μg/dL, P < 0.001). Ammonia levels correlated with PHG severity score (r = 0.830, P < 0.001), Child-Pugh score (r = 0.554, P = 0.004), portal vein diameter (r = 0.540, P = 0.005), and spleen size (r = 0.778, P < 0.001). At a cutoff of >120 μg/dL, ammonia had 100% sensitivity, 92.3% specificity, and 96.2% accuracy in differentiating severe from mild PHG. Conclusion: Serum ammonia is a strong predictor of PHG severity in cirrhotic patients, correlating with endoscopic and ultrasonographic parameters. It may serve as a valuable non-invasive biomarker for risk stratification in PHG. | ||
| Keywords | ||
| Ammonia; Cirrhosis; Non-Invasive Marker; Portal Hypertensive Gastropathy; Portal Hypertension | ||
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