Association of Grading of Esophageal Varices with Child Turcotte Pugh Class in Patients of Liver Cirrhosis

Objective: To determine the association between the Child Turcotte Pugh class and the esophageal variceal grade in pediatric patients with liver cirrhosis. Methodology: This was a cross-sectional study spanning from December 2022 to August 2023, involving children of age 4-14 years with liver cirrhosis at the Pediatric Gastroenterology and Hepatology Department, Department of Paediatric, Combined Military Hospital, Rawalpindi; patients were classified into Child-Pugh-Turcotte Classes A, B, or C based on laboratory and clinical parameters. All underwent upper gastrointestinal endoscopy to screen for varices. Data analysis was performed using SPSS version 20, with a p-value of <0.05 considered significant. Results: The study involved patients with a mean age of 7.3±3.0 years, 55% male and 45% female. Glycogen Storage Disorder (23%) and Progressive Familial Intrahepatic Cholestasis (17%) were the main causes of liver cirrhosis. Upper gastrointestinal (UGI) endoscopy showed 77.6% had varices, with 30.6% Grade-I and 26.5% Grade-III. Screening for esophageal varices was the most common indication (47%). Among patients with hematemesis, 57% had Grade-III varices, compared to 13% of those screened, 33% with malena, and none with abdominal pain (p=0.03). In the Child-Pugh-Turcotte classification, 42% of Class-A had no varices, while 25% had Grade III; 50% of Class-B had Grade-I, and 40% of Class-C had Grade-III varies (p=0.08). Conclusion: The Child-Pugh-Turcotte score is a valuable non-invasive tool for assessing morbidity and mortality in pediatric liver cirrhosis. It effectively stratifies patients based on variceal presence and grade, aiding in clinical management and outcome prediction. Routine use of this score can improve prognostic accuracy and treatment planning for these patients.